Evidence map›Paper›PMID 41921912›Full record

ArticleAnnals of vascular surgery2026

Underuse of Preoperative Testing Before Index Peripheral Vascular Interventions for Claudication in the Outpatient Setting.

Terrence C Tsou, Chen Dun, Midori White, Katherine M McDermott, Y H Andrew Wu, M Libby Weaver, Corey Kalbaugh, Jeffrey J Siracuse, Maya Salameh, James H Black and 1 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of vascular surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Terrence C TsouDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Chen DunDepartment of Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Midori WhiteDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Katherine M McDermottDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Y H Andrew WuDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
M Libby WeaverDivision of Vascular Surgery, Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA.
Corey KalbaughDepartment of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA.
Jeffrey J SiracuseDivision of Vascular and Endovascular Surgery, Boston Medical Center, Boston, MA, USA.
Maya SalamehDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
James H BlackDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Caitlin W HicksDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA. Electronic address: chicks11@jhmi.edu.

Funding

CARDIOVASCULAR EPIDEMIOLOGY INSTITUTIONAL TRAININGT32HL007024 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI Elizabeth Selvin · 1985 to 2026
$17.5M
Risk Factors and Outcomes Associated with Late-Life Diabetic Peripheral NeuropathyK23DK124515 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI HICKS, CAITLIN WHITNEY · 2020 to 2024
$898k
NHLBI NIH HHS T32 HL007024NIDDK NIH HHS K23 DK124515
6 · The paper itself

Abstract

backgroundGuidelines across vascular surgery, cardiology, and radiology specialties recommend appropriate preoperative testing prior to revascularization for claudication. We aimed to identify patient and physician characteristics associated with the absence of preoperative testing before peripheral vascular interventions (PVIs) performed for claudication.

methodsUsing 100% Medicare fee-for-service claims data, we identified all patients undergoing an index PVI for claudication between 01/2017 and 12/2024. We used CPT codes to identify preoperative testing, which included noninvasive physiologic studies (ABI, pulse volume recordings [PVRs]), near infrared thermography, duplex ultrasound, MRA of the abdomen and pelvis with runoff, CTA of the abdomen and pelvis with runoff, MRA of the lower extremity, or CTA of the lower extremity. Lack of preoperative testing was defined as no preoperative test within 3 months prior to index PVI. We evaluated the associations of patient and physician characteristics with the lack of preoperative testing using multivariable hierarchical logistic regression. We performed sensitivity analyses defining lack of preoperative testing as no testing within 6 and 12 months prior to index PVI.

resultsOf 167,406 patients undergoing index PVI for claudication by 3,771 physicians, 27.4% received no preoperative testing. The odds of receiving no preoperative testing significantly increased over time (adjusted odds ratio [aOR] 1.02 per year, 95% confidence interval [95% CI] 1.02-1.03). Patients without preoperative testing were more likely to be age ≤ 64 years (versus age 65-74, aOR 1.06, 95% CI 1.01-1.11), Black (versus White, aOR 1.10, 95% CI 1.05-1.15), or Hispanic (versus White, aOR 1.20, 95% CI 1.11-1.31), and to receive an iliac intervention (aOR 1.29, 95% CI 1.22-1.36). Patients treated by physicians of cardiology (aOR, 1.98; 95% CI, 1.87-2.10), radiology (aOR, 1.20; 95% CI, 1.09-1.33), and other nonvascular surgery specialties (aOR, 1.27; 95% CI, 1.13-1.42) had higher odds of not receiving preoperative testing compared to patients treated by vascular surgeons. Sensitivity analyses using 6 and 12 months as the time cutoff for testing prior to PVI did not substantially change the results.

conclusionCompliance with society guidelines for preoperative testing prior to outpatient PVI for claudication varies substantially by patient and physician characteristics. Cross-specialty adherence will help ensure patients with claudication receive consistent, evidence-based, high-value care.

Indexed as

Ambulatory CareDiagnostic ImagingIntermittent ClaudicationPeripheral Arterial DiseasePractice Patterns, Physicians'Preoperative CareVascular Surgical ProceduresAdministrative Claims, HealthcareAgedAged, 80 and overClinical RelevanceDatabases, FactualFemaleHumansMaleMedicare

Identifiers

PMID41921912
PMCPMC13134929

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.