Abstract:
BACKGROUND:We apply an innovative and novel analytic approach, based on reliability engineering (RE) principles frequently used to characterize the behavior of manufactured products, to examine outcomes after peripheral endovascular intervention. We hypothesized that this would allow for improved prediction of outcome after peripheral endovascular intervention, specifically with regard to identification of risk factors for early failure. METHODS:Patients undergoing infrainguinal endovascular intervention for chronic lower-extremity ischemia from 2005 to 2010 were identified in a prospectively maintained database. The primary outcome of failure was defined as patency loss detected by duplex ultrasonography, with or without clinical failure. Analysis included univariate and multivariate Cox regression models, as well as RE-based analysis including product life-cycle models and Weibull failure plots. Early failures were distinguished using the RE principle of "basic rating life," and multivariate models identified independent risk factors for early failure. RESULTS:From 2005 to 2010, 434 primary endovascular peripheral interventions were performed for claudication (51.8%), rest pain (16.8%), or tissue loss (31.3%). Fifty-five percent of patients were aged ≥75 years; 57% were men. Failure was noted after 159 (36.6%) interventions during a mean follow-up of 18 months (range, 0-71 months). Using multivariate (Cox) regression analysis, rest pain and tissue loss were independent predictors of patency loss, with hazard ratios of 2.5 (95% confidence interval, 1.6-4.1; P < 0.001) and 3.2 (95% confidence interval, 2.0-5.2, P < 0.001), respectively. The distribution of failure times for both claudication and critical limb ischemia fit distinct Weibull plots, with different characteristics: interventions for claudication demonstrated an increasing failure rate (β = 1.22, θ = 13.46, mean time to failure = 12.603 months, index of fit = 0.99037, R(2) = 0.98084), whereas interventions for critical limb ischemia demonstrated a decreasing failure rate, suggesting the predominance of early failures (β = 0.7395, θ = 6.8, mean time to failure = 8.2, index of fit = 0.99391, R(2) = 0.98786). By 3.1 months, 10% of interventions failed. This point (90% reliability) was identified as the basic rating life. Using multivariate analysis of failure data, independent predictors of early failure (before 3.1 months) included tissue loss, long lesion length, chronic total occlusions, heart failure, and end-stage renal disease. CONCLUSIONS:Application of a RE framework to the assessment of clinical outcomes after peripheral interventions is feasible, and potentially more informative than traditional techniques. Conceptualization of interventions as "products" permits application of product life-cycle models that allow for empiric definition of "early failure" may facilitate comparative effectiveness analysis and enable the development of individualized surveillance programs after endovascular interventions.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Meltzer AJ,Graham A,Connolly PH,Karwowski JK,Bush HL,Frazier PI,Schneider DBdoi
10.1016/j.avsg.2012.05.002subject
Has Abstractpub_date
2013-01-01 00:00:00pages
53-61issue
1eissn
0890-5096issn
1615-5947pii
S0890-5096(12)00284-1journal_volume
27pub_type
杂志文章abstract::We report a massive infected pseudoaneurysm of the right external iliac artery in the setting of Girdlestone pseudoarthroplasty (GSA) for chronic infection. Around the time of her GSA, the patient underwent cardiac catheterization with resultant pseudoaneurysm formation. Infection was likely due to spread from her pre...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.07.070
更新日期:2017-04-01 00:00:00
abstract::Thirty-two patients undergoing elective infrarenal aortic surgery were randomly assigned to receive a perioperative infusion of either dopexamine hydrochloride at a rate of 2 micrograms/kg/min (n = 15) or 0.9% saline solution as placebo (n = 17). Renal function was monitored by regular measurements of serum creatinine...
journal_title:Annals of vascular surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/BF02143865
更新日期:1995-09-01 00:00:00
abstract::The association of aortic and common iliac artery aneurysms requires a special strategy to achieve distal seal during the endovascular exclusion of abdominal aortic aneurysms. Coil embolization of the internal iliac artery before the placement of a bifurcated endograft limb into the external iliac artery is a usual op...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2009.08.014
更新日期:2010-04-01 00:00:00
abstract::Endofibrosis of the external iliac artery is a rare cause of performance-limiting claudication in elite athletes. We describe a 47-year-old male competitive cyclist and a 52-year-old female former international triathlete, with unilateral and bilateral external artery occlusions, respectively, who presented with disab...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2013.01.012
更新日期:2013-11-01 00:00:00
abstract::The purpose of this study was to evaluate the feasibility of transluminal techniques in an unselected group of patients and to assess long-term outcome in successful procedures. All patients in whom iliac artery recanalization was attempted were included in this study. Patients with an occluded prosthesis or recent em...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0890-5096(06)60452-4
更新日期:1995-01-01 00:00:00
abstract::In patients with Takayasu's arteritis presenting with cerebrovascular insufficiency, deciding whether and how to perform surgical intervention is difficult. We report successful extra-anatomical cerebrovascular reconstruction in a patient with Takayasu's arteritis involving the aortic arch. A 27-year-old woman was dia...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-005-7714-7
更新日期:2005-11-01 00:00:00
abstract:BACKGROUND:Based on current evidence, one-time screening for abdominal aortic aneurysm (AAA) in men using ultrasound evaluation reduces mortality related to AAA rupture and is considered cost-effective, although all-cause mortality reduction still remains in question. In Spain, there is no population screening program ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.11.042
更新日期:2020-12-30 00:00:00
abstract::Previous reports have suggested "short" focal stenoses in peripheral vein grafts (PVGs), namely less than 2 cm long, can be successfully balloon dilated with good long-term patency rates. We questioned if enthusiasm for balloon angioplasty of these lesions in failing PVGs is warranted. Between August 1, 1993 and Decem...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900129
更新日期:1998-03-01 00:00:00
abstract::Spontaneous dissection of the superior mesenteric artery represents a rare cause of abdominal angina. Conservative or more aggressive treatments such as surgery or endovascular therapy depend on the symptoms. We present a case report of acute mesenteric ischemia due to spontaneous dissection of the superior mesenteric...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2008.12.004
更新日期:2009-07-01 00:00:00
abstract::We report a rare case of primary aortoduodenal fistula (ADF) secondary to a Coxiella burnetii (Q fever) infection in a patient with an abdominal aortic aneurysm. A review of the available literature on the vascular complications of Q fever is presented. Q fever should be suspected in vascular patients with close anima...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169910046
更新日期:2000-05-01 00:00:00
abstract::We present a case of totally robotic ligation of the inferior mesenteric artery (IMA) for treatment of a persistent endoleak from the IMA into the aneurysm sac after endovascular aneurysm repair (EVAR). An 84-year-old male underwent EVAR with a Gore Excluder stent graft for an asymptomatic infrarenal abdominal aortic ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2008.02.019
更新日期:2009-03-01 00:00:00
abstract::Twenty-two cases of vertebral arteriovenous fistulas treated by embolization are reported. Although such fistulas are usually asymptomatic they may be occasionally responsible for tinnitus. Neurologic complications are exceptional. Spontaneous fistulas have been found predominantly in the C1-C2 region (9 of 13 cases),...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)60706-1
更新日期:1986-05-01 00:00:00
abstract::Current methods of ligating venous branches during in situ vein tibial bypass are associated with significant wound complications, especially in diabetics. Making only proximal and distal wound incisions could avoid these wound problems. We report the use of endovascular techniques with coils and balloons guided by in...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02002882
更新日期:1993-07-01 00:00:00
abstract::Between March and October 1986, 33 consecutive patients underwent unilateral lumbar sympathectomy in the Thoracic and Cardiovascular Surgical Unit of the Catholic University in Louvain, Belgium. Ten patients experienced postsympathectomy neuralgia. After a single epidural injection of fentanyl, 50 micrograms, and meth...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(07)60015-6
更新日期:1988-07-01 00:00:00
abstract:BACKGROUND:The purpose of this study is to evaluate 2 patients who underwent endovascular repair directly after acute life-threatening vascular injury complicating lumbar disc surgery, and to update an overview of the literature from 2002 to gain insights into characteristics, diagnosis, treatment, and outcomes of this...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2012.07.019
更新日期:2013-08-01 00:00:00
abstract::Bacillus Calmette-Guérin (BCG) therapy is often associated with side effects. The most feared is disseminated sepsis that may occur rarely with the development of mycotic aortic aneurysms. Twenty cases of patients treated with intravesical BCG complicated by mycotic abdominal aortic aneurysm have been reported in the ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.01.036
更新日期:2015-08-01 00:00:00
abstract::Surgical reconstruction for patients with symptomatic lower extremity arterial occlusive disease is successful when a suitable distal target vessel is present. In patients with unreconstructable disease, practical surgical options are at a minimum. We report our initial experience with dorsal venous arch arterializati...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-001-0148-y
更新日期:2002-03-01 00:00:00
abstract::Routine intraoperative imaging of the carotid artery following carotid endarterectomy can detect defects at the site of endarterectomy that may lead to neurologic morbidity. A number of methods have been used to evaluate the completed endarterectomy. In this prospective study we compared subjective methods of assessme...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02135281
更新日期:1995-05-01 00:00:00
abstract::The use of a patch after carotid endarterectomy (CE) is recommended to reduce the incidence of restenosis. Most studies on this subject report the implantation of saphenous vein or PTFE patches, because polyester has always been considered to be a thrombogenic material. The purpose of this study was to evaluate the th...
journal_title:Annals of vascular surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s100160010129
更新日期:2001-11-01 00:00:00
abstract:BACKGROUND:Endovenous ablation of great (GSV) and short saphenous vein (SSV) reflux has become the initial procedure for most patients with symptomatic venous insufficiency, and perforator ablation is increasingly used to assist in healing venous ulceration. Many patients have comorbid conditions, which require long-te...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.10.019
更新日期:2012-07-01 00:00:00
abstract::We describe a case of gluteal compartment syndrome (GCS) after a 4-vessel fenestrated endovascular abdominal aortic aneurysm repair. The case highlights the need for a high index of suspicion for GCS as a differential diagnosis for spinal cord ischemia in patients developing perioperative lower limb neurologic deficit...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.07.029
更新日期:2016-01-01 00:00:00
abstract::The complex interactions occurring at the blood/material interface of implanted blood-contacting biomaterials largely determine the clinical efficacy of small diameter vascular grafts. Physical characteristics of the material such as chemical composition, electrical charge, surface texture, elastic modulus, and porosi...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02042699
更新日期:1990-01-01 00:00:00
abstract::Twenty-nine cases of post-traumatic false aneurysms and arteriovenous fistulas (AVF), with a mean follow-up of 24 months (1-65 months), are presented here. Diagnosis was established by color duplex and arteriogram. The time between injury and treatment varied between 3 days and 61 months. Endovascular treatment was ac...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900230
更新日期:1999-03-01 00:00:00
abstract:BACKGROUND:This study examines the outcome of hybrid revascularization combining iliofemoral endarterectomy and iliac artery stenting using covered stents in TransAtlantic Inter-Society Consensus (TASC) C and D aortoiliac occlusive disease (AIOD) involving the common femoral artery (CFA). METHODS:A retrospective revie...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.11.061
更新日期:2018-07-01 00:00:00
abstract::This report details the case of a patient presenting with a periampullary cancer and an abdominal aortic aneurysm who underwent endovascular repair of the aneurysm prior to pancreaticoduodenectomy. Use of the endovascular approach avoided the need for two major operative interventions. ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-005-9406-8
更新日期:2006-01-01 00:00:00
abstract::Forty consecutive patients were admitted alive to the operating theater with ruptured infrarenal aoritc aneurysms in a 3-year period and were assessed preoperatively with two scoring systems: the POSSUM (physiological and operative severity score for the enumeration of mortality) and the APACHE II (acute physiologic a...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900026
更新日期:1997-03-01 00:00:00
abstract:BACKGROUND:Diabetes mellitus is a major risk factor for progression to lower extremity amputation (LEA) due to progressive neuropathy and glycemia-induced vasculopathy. In this study, we evaluated risk factors for incident LEA type 2 diabetics during a randomized controlled trial and extended post-trial follow-up. MET...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.10.022
更新日期:2020-11-26 00:00:00
abstract::Advanced complicated atherosclerotic lesions have been related to many factors, including inflammation, infectious agents, and growth factors. Mycoplasma pneumoniae (MP) and Chlamydia pneumoniae (CP), inflammation, and growth factors have been associated with severe atherosclerotic lesions in necropsy material in rece...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-006-9076-1
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:Femoropopliteal bypass is a common vascular reconstructive procedure. A significant proportion of bypasses become ineffective within 1 year because of occlusion due to progression of intimal hyperplasia (IH). METHODS:The clinical part of the study involved an analysis of 43 patients with proximal femoropopl...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2009.06.008
更新日期:2009-09-01 00:00:00
abstract::This study was designed to compare outcomes following infrainguinal bypass between patients with end-stage renal disease (ESRD) and patients with normal renal function (NRF). Sixty-three patients with ESRD undergoing 78 infrainguinal bypasses from 1990 to 1999 were compared with a concurrent group of 132 age-, race-, ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100160010067
更新日期:2001-05-01 00:00:00