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  1. AU="Elliott, Bruce M"
  2. AU="Pérez, René"
  3. AU="Lourdes Diaz Rodriguez"
  4. AU="Choi, Kai Chow"
  5. AU="Brandolini, Jury"
  6. AU="Yom, Jina"
  7. AU="Sue Casey"
  8. AU="Arimura, Takashi"
  9. AU="Kizilkilic, Osman"

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  1. Artikel ; Online: Conflict of interest and the Society for Vascular Surgery.

    Elliott, Bruce M

    Journal of vascular surgery

    2011  Band 54, Heft 3 Suppl, Seite(n) 3S–11S

    Abstract: Specialty medical societies such as Society for Vascular Surgery (SVS) are instrumental in the development and dissemination of medical knowledge through scientific presentations, publication of rigorously peer-reviewed writings, awarding competitive ... ...

    Abstract Specialty medical societies such as Society for Vascular Surgery (SVS) are instrumental in the development and dissemination of medical knowledge through scientific presentations, publication of rigorously peer-reviewed writings, awarding competitive research and training grants, and the provision of high-quality continuing medical education (CME). It is vital that in these roles the SVS remain in fact and in perception completely free of all influence and bias from industry. While independence from bias has always been necessary, the increasing focus by governmental agencies, industry organizations, and society has made it important for the SVS to address this issue in a formal way. In June 2010, the SVS Board of Directors approved a set of guidelines specifically designed to address management of conflict of interest among its members and its leaders. These guidelines, included in this article, were based on currently available information and policies put forth by legislative bodies, academic medical centers, industry groups, and other professional medical societies, and were designed to safeguard against abuse while maintaining valuable collaboration between vascular surgeons and their industry partners. The guidelines are included in this article.
    Mesh-Begriff(e) Bias ; Codes of Ethics ; Conflict of Interest ; Cooperative Behavior ; Diffusion of Innovation ; Health Care Sector/ethics ; Health Care Sector/standards ; Humans ; Interinstitutional Relations ; Interprofessional Relations/ethics ; Leadership ; Scientific Misconduct ; Societies, Medical/ethics ; Societies, Medical/standards ; Vascular Surgical Procedures/ethics ; Vascular Surgical Procedures/standards
    Sprache Englisch
    Erscheinungsdatum 2011-09
    Erscheinungsland United States
    Dokumenttyp Guideline ; Journal Article
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2011.04.066
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  2. Artikel: Bypass and embolization for a vertebral artery aneurysm in a patient with Marfan syndrome.

    Johnson-Mann, Crystal / Schonholz, Claudio / Vandergrift, William / Elliott, Bruce M / Brothers, Thomas

    Journal of vascular surgery cases

    2015  Band 1, Heft 2, Seite(n) 77–80

    Abstract: Extracranial vertebral artery aneurysms represent an uncommon presentation of collagen vascular disease. We performed staged proximal embolization of large left vertebral artery aneurysm after distal common carotid-to-vertebral bypass at C2 in a young ... ...

    Abstract Extracranial vertebral artery aneurysms represent an uncommon presentation of collagen vascular disease. We performed staged proximal embolization of large left vertebral artery aneurysm after distal common carotid-to-vertebral bypass at C2 in a young adult patient with Marfan syndrome and a hypoplastic contralateral vertebral artery. Dilation of the autogenous saphenous vein graft occurred at 1 year with proximal graft stenosis requiring operative revision. Subsequent dilation of the basilar artery led to symptoms of pontine compression at 18 months that have resolved at 31 months of follow-up.
    Sprache Englisch
    Erscheinungsdatum 2015-04-21
    Erscheinungsland Netherlands
    Dokumenttyp Journal Article
    ZDB-ID 2834229-X
    ISSN 2352-667X
    ISSN 2352-667X
    DOI 10.1016/j.jvsc.2015.02.002
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  3. Artikel ; Online: Predictors of prosthetic graft infection after infrainguinal bypass.

    Brothers, Thomas E / Robison, Jacob G / Elliott, Bruce M

    Journal of the American College of Surgeons

    2009  Band 208, Heft 4, Seite(n) 557–561

    Abstract: Background: Some patients require major leg amputation after lower-extremity prosthetic bypass for graft occlusion or failure of wound healing, despite a patent graft. Amputation above or below the knee was hypothesized to increase susceptibility to ... ...

    Abstract Background: Some patients require major leg amputation after lower-extremity prosthetic bypass for graft occlusion or failure of wound healing, despite a patent graft. Amputation above or below the knee was hypothesized to increase susceptibility to prosthetic graft infection in the ipsilateral extremity.
    Study design: All patients undergoing implantation of prosthetic infrainguinal arterial bypass grafts identified from a vascular surgical registry during a 12-year period were reviewed. Patient demographic data, comorbid conditions, and operative details were evaluated as risk factors, with graft infection among the primary outcomes of interest.
    Results: Prosthetic graft infection occurred in 25 of 141 (18%) infrainguinal grafts and occurred most frequently after major amputation (41% versus 6%; odds ratio [OR] = 12; 95% CI, 4.1 to 34) or early reoperation after initial grafting (70% versus 16%; OR = 11; 95% CI, 1.9 to 63). Risk was highest after amputation within 4 weeks of bypass (70% versus 32%; OR = 5.0; 95% CI, 1.1 to 23). Graft thrombosis (84% versus 39%; OR = 8.3; 95% CI, 2.7 to 26) and presence of gangrene (52% versus 23%; OR = 3.6; 95% CI, 1.5 to 8.7) also increased infection risk. Independent predictors for development of graft infection were identified by stepwise regression analysis to be amputation (p < 0.001), early reoperation (p = 0.002), and absence of renal failure (p = 0.038) but not gangrene (p = 0.090). Amputations performed within 6 months of the initial bypass operation were more likely to be associated with prosthetic graft infection than those performed later than 6 months (52% versus 17%; OR = 5.3; 95% CI, 1.3 to 22).
    Conclusions: Amputation increases risk of prosthetic graft infection, especially when performed early or after failed revascularization. Consideration should be given to partial or complete removal of a prosthetic graft above the level of the amputation under these conditions.
    Mesh-Begriff(e) Aged ; Amputation ; Blood Vessel Prosthesis/adverse effects ; Blood Vessel Prosthesis Implantation ; Comorbidity ; Female ; Humans ; Inguinal Canal/surgery ; Limb Salvage/statistics & numerical data ; Male ; Middle Aged ; Polytetrafluoroethylene ; Postoperative Period ; Prosthesis-Related Infections/epidemiology ; Retrospective Studies ; Risk Factors ; Time Factors ; Vascular Patency
    Chemische Substanzen Polytetrafluoroethylene (9002-84-0)
    Sprache Englisch
    Erscheinungsdatum 2009-04
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1016/j.jamcollsurg.2009.01.001
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  4. Artikel ; Online: Increasing the proportion of autologous arteriovenous fistulas does not diminish fistula patency.

    Ruddy, Jean Marie / Brothers, Thomas E / Robison, Jacob G / Elliott, Bruce M

    Vascular and endovascular surgery

    2011  Band 45, Heft 1, Seite(n) 51–54

    Abstract: Objective: Arteriovenous fistulas (AVF) constructed before and after initiating the kidney disease outcomes and quality initiative (KDOQI) guidelines were reviewed at a single academic center to identify decreased patency with use of potentially ... ...

    Abstract Objective: Arteriovenous fistulas (AVF) constructed before and after initiating the kidney disease outcomes and quality initiative (KDOQI) guidelines were reviewed at a single academic center to identify decreased patency with use of potentially inferior vein conduits.
    Methods: Primary access procedures performed pre- and post-adoption of KDOQI guidelines were compared for the primary outcomes of maturation rate and primary patency and the secondary outcome of access utilization.
    Results: The proportion of autologous AVFs created was higher post-KDOQI (73% vs 35%, P < .001), and an increased use of the basilic vein was observed (20% vs 2%, P < .05). The failure rate of fistula maturation was reduced post-KDOQI (24% vs 38%, P < .05); however, access utilization was also decreased (59% vs 75%, P < .001).
    Conclusions: Adherence to KDOQI guidelines for AVFs does not compromise fistula patency and increased use of the basilic vein may lead to superior fistula maturation rates. Early referral may result in lower fistula utilization rates, however.
    Mesh-Begriff(e) Academic Medical Centers ; Adult ; Aged ; Arteriovenous Shunt, Surgical ; Chi-Square Distribution ; Guideline Adherence ; Humans ; Kaplan-Meier Estimate ; Middle Aged ; Practice Guidelines as Topic ; Renal Dialysis ; Retrospective Studies ; South Carolina ; Time Factors ; Transplantation, Autologous ; Treatment Outcome ; Vascular Patency ; Veins/transplantation
    Sprache Englisch
    Erscheinungsdatum 2011-01
    Erscheinungsland United States
    Dokumenttyp Comparative Study ; Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2076272-0
    ISSN 1938-9116 ; 1538-5744
    ISSN (online) 1938-9116
    ISSN 1538-5744
    DOI 10.1177/1538574410388310
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  5. Artikel: Prospective decision analysis for peripheral vascular disease predicts future quality of life.

    Brothers, Thomas E / Robison, Jacob G / Elliott, Bruce M

    Journal of vascular surgery

    2007  Band 46, Heft 4, Seite(n) 701–708; discussion 708

    Abstract: Objective: Decision making for peripheral vascular disease can be quite complex as a result of pre-existing compromise of patient functional status, anatomic considerations, uncertainty of favorable outcome, medical comorbidities, and limitations in ... ...

    Abstract Objective: Decision making for peripheral vascular disease can be quite complex as a result of pre-existing compromise of patient functional status, anatomic considerations, uncertainty of favorable outcome, medical comorbidities, and limitations in life expectancy. The ability of prospective decision-analysis models to predict individual quality of life in patients with lower extremity arterial occlusive disease was tested.
    Methods: This was a prospective cohort study. The settings were university and Veterans Administration vascular surgery practices. All 214 patients referred with symptomatic lower extremity arterial disease of any severity over a 2-year period were screened, and 206 were enrolled. A Markov model was compared with standard clinical decision-making. Utility assessment and generalized (Short Form-36; SF-36) and disease-specific (Walking Impairment Questionnaire; WIQ) quality of life were derived before treatment. Estimates of treatment outcome probabilities and intended and actual treatment plans were provided by attending vascular surgeons. The main outcome measures were generalized (SF-36) and disease-specific (WIQ) variables at study entry and at 4 and 12 months.
    Results: Primary intervention consisted of amputation for 9, bypass for 42, angioplasty for 8, and medical treatment for 147 patients. Considering all patients, no improvement in mean overall patient quality of life measured by the SF-36 Physical Component Score (27 +/- 8 vs 28 +/- 8; P = .87) or WIQ (39 +/- 22 vs 39 +/- 23; P = .13) was noted 12 months after counseling and treatment by the vascular surgeons. Individually considered SF-36 categories were improved only for Bodily Pain (40 +/- 23 vs 49 +/- 25; P = .03), with the most significant improvement observed among patients with the most severe pain (68 +/- 25 vs 37 +/- 23; P = .02) and among those undergoing bypass (60 +/- 29 vs 31 +/- 22; P = .02). It is noteworthy that when the treatment chosen was incongruent with the Markov model, patients were more likely to report a poorer quality of life at 1 year (Physical Component Score, 25 +/- 8 vs 29 +/- 8; P < .001). The quality of life predicted at baseline by the Markov model correlated positively with the Physical Component Score (r = 0.23), Bodily Pain (r = 0.33), and Fatigue (r = 0.44) and negatively with WIQ (r = -0.08) observed 1 year later.
    Conclusions: Prospective application of an individualized decision Markov model in patients with vascular disease was predictive of patient quality of life at 1 year. The patient's outcome was worse when the treatment received did not follow the model's recommendation. This decision analysis model may be useful to identify patients at risk for poor outcomes with standard clinical decision making.
    Mesh-Begriff(e) Aged ; Amputation ; Angioplasty ; Decision Support Techniques ; Female ; Humans ; Locomotion ; Lower Extremity/blood supply ; Lower Extremity/surgery ; Male ; Markov Chains ; Middle Aged ; Peripheral Vascular Diseases/surgery ; Quality of Life ; Vascular Surgical Procedures
    Sprache Englisch
    Erscheinungsdatum 2007-10
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2007.05.045
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  6. Artikel: Compromised bypass graft outcomes after minimal-incision vein harvest.

    Pullatt, Rana / Brothers, Thomas E / Robison, Jacob G / Elliott, Bruce M

    Journal of vascular surgery

    2006  Band 44, Heft 2, Seite(n) 289–94; discussion 294–5

    Abstract: Background: Minimal incision techniques for vein harvest may lessen wound complications after lower extremity revascularization, but long-term patency and limb salvage data are limited.: Methods: This retrospective case-control study used a ... ...

    Abstract Background: Minimal incision techniques for vein harvest may lessen wound complications after lower extremity revascularization, but long-term patency and limb salvage data are limited.
    Methods: This retrospective case-control study used a computerized vascular registry set in an academic vascular surgical practice. All patients undergoing lower extremity revascularization using autogenous reversed great saphenous vein by a single vascular surgeon in a 10-year period were reviewed. Harvest of great saphenous vein via long single incision (SI) in 133 patients was compared with minimal incisions with endoscopy (MIE) in 85, or MI without endoscopy in 106. The main outcome measures were primary and secondary graft patency by Kaplan-Meier life-table analysis and cumulative sum failure (CUSUM). Secondary outcomes of interest were limb salvage and wound complications.
    Results: No differences were observed between MIE, MI, and SI patients for demographic data, risk factors, or primary indications, including claudication, rest pain, ischemic ulcer, and gangrene. Endoscopic vein harvest patients were significantly more likely than MI or SI to be women and more likely to use tobacco. Primary patency at 5 years was better after SI vein harvest (59%) than with either MI (33%, P = .004) or MIE (44%, P = .045) techniques, although both MI groups had a higher proportion of bypass grafts to the popliteal artery. Similarly, cumulative secondary patency was better after SI (66%) than with MI (47%, P = .045), but not MIE (58%, P = .45). Differences in limb salvage at 5 years in SI (73%) were not statistically superior to either MI (59%, P = .24) or MIE (58%, P = .13). No learning curve for MI or MIE vein grafts was evident by CUSUM for primary patency at 12 months. No differences in wound complication rates were observed for SI (9%), MI (10%), or MIE (6%) grafts (P = .54).
    Conclusions: Graft patency and limb salvage deteriorated during the time when MI or MIE techniques of great saphenous vein harvest were adopted. This observation raises concern about the advisability of limiting the extent of the incision at the potential cost of compromised outcomes without an obvious advantage in limiting wound complications.
    Mesh-Begriff(e) Aged ; Endoscopy/methods ; Female ; Humans ; Lower Extremity/blood supply ; Male ; Medical Records Systems, Computerized ; Middle Aged ; Peripheral Vascular Diseases/surgery ; Retrospective Studies ; Saphenous Vein/transplantation ; Tissue and Organ Harvesting/methods ; Treatment Outcome ; Vascular Patency
    Sprache Englisch
    Erscheinungsdatum 2006-08
    Erscheinungsland United States
    Dokumenttyp Comparative Study ; Journal Article
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2006.02.072
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  7. Artikel: Suprarenal Clostridium septicum aortitis with rupture and simultaneous colon cancer.

    Mohamed, Hussein K / Elliott, Bruce M / Brothers, Thomas E / Robison, Jacob G

    Annals of vascular surgery

    2006  Band 20, Heft 6, Seite(n) 825–829

    Abstract: We report a case of combined colon cancer and Clostridium septicum aortitis involving the suprarenal abdominal aorta with rupture. An 82-year-old male presented with fever, abdominal pain, and back pain associated with constipation. He was successfully ... ...

    Abstract We report a case of combined colon cancer and Clostridium septicum aortitis involving the suprarenal abdominal aorta with rupture. An 82-year-old male presented with fever, abdominal pain, and back pain associated with constipation. He was successfully treated by in situ aortic graft placement with polytetrafluroethylene and concomitant colon resection. Only 20 other cases of C. septicum mycotic aneurysm, aortitis, or aortic dissection have been reported. Concomitant surgical treatment for Clostridium aortitis or mycotic abdominal aortic aneurysm and colon cancer can be accomplished successfully in selected cases when the diagnosis of both conditions is made preoperatively.
    Mesh-Begriff(e) Aged, 80 and over ; Aneurysm, False/microbiology ; Aneurysm, Infected/microbiology ; Aortic Aneurysm, Abdominal/microbiology ; Aortic Rupture/complications ; Aortic Rupture/diagnostic imaging ; Aortic Rupture/microbiology ; Aortic Rupture/surgery ; Aortitis/complications ; Aortitis/diagnostic imaging ; Aortitis/microbiology ; Aortitis/surgery ; Blood Vessel Prosthesis Implantation ; Clostridium Infections/complications ; Clostridium Infections/microbiology ; Clostridium septicum/isolation & purification ; Colectomy ; Colonic Neoplasms/complications ; Colonic Neoplasms/diagnostic imaging ; Colonic Neoplasms/surgery ; Humans ; Male ; Polytetrafluoroethylene ; Tomography, X-Ray Computed ; Treatment Outcome
    Chemische Substanzen Polytetrafluoroethylene (9002-84-0)
    Sprache Englisch
    Erscheinungsdatum 2006-11
    Erscheinungsland Netherlands
    Dokumenttyp Case Reports ; Journal Article
    ZDB-ID 1027366-9
    ISSN 1615-5947 ; 0890-5096
    ISSN (online) 1615-5947
    ISSN 0890-5096
    DOI 10.1007/s10016-006-9073-4
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  8. Artikel: Prophylactic beta-blocker use to prevent perioperative morbidity and mortality.

    Finley, Alan C / Elliott, Bruce M / Robison, Jacob J / Brothers, Thomas E

    Journal of the South Carolina Medical Association (1975)

    2004  Band 100, Heft 8, Seite(n) 223–226

    Abstract: Cardiovascular disease continues to be a major health concern and leads to significant perioperative morbidity and mortality. Evidence for prophylactic use of beta-blockade to decrease these complications continues to grow. Not all patients benefit from ... ...

    Abstract Cardiovascular disease continues to be a major health concern and leads to significant perioperative morbidity and mortality. Evidence for prophylactic use of beta-blockade to decrease these complications continues to grow. Not all patients benefit from perioperative beta-blockade, thus a thorough preoperative cardiac assessment should be performed with every patient undergoing surgery. Although physicians may have doubts with this new strategy, the literature overwhelmingly supports prophylactic beta-blockade use as a safe, efficacious, and cost effective new therapy in patients at risk for cardiac complications.
    Mesh-Begriff(e) Adrenergic beta-Antagonists/therapeutic use ; Humans ; Intraoperative Complications/mortality ; Intraoperative Complications/prevention & control ; Myocardial Ischemia/etiology ; Myocardial Ischemia/mortality ; Myocardial Ischemia/prevention & control ; Perioperative Care/standards ; Premedication ; Risk Assessment
    Chemische Substanzen Adrenergic beta-Antagonists
    Sprache Englisch
    Erscheinungsdatum 2004-08
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Review
    ZDB-ID 603510-3
    ISSN 0038-3139
    ISSN 0038-3139
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  9. Artikel ; Online: Combined carotid endarterectomy and coronary artery bypass grafting versus coronary artery bypass grafting alone: a retrospective review of outcomes at our institution.

    Dick, Amanda M / Brothers, Thomas / Robison, Jacob G / Elliott, Bruce M / Kratz, John M / Toole, J Matthew / Crumbley, Arthur J / Crawford, Fred A

    Vascular and endovascular surgery

    2011  Band 45, Heft 2, Seite(n) 130–134

    Abstract: Background: It remains controversial whether patients with concomitant carotid and coronary disease should undergo operative repair separately or in combination.: Methods: Patients with documented cerebrovascular disease undergoing coronary artery ... ...

    Abstract Background: It remains controversial whether patients with concomitant carotid and coronary disease should undergo operative repair separately or in combination.
    Methods: Patients with documented cerebrovascular disease undergoing coronary artery bypass grafting (CABG) alone were matched by propensity scoring with patients undergoing combined carotid endarterectomy (CEA)/CABG procedures and compared for the occurrence of stroke, myocardial infarction (MI), and mortality.
    Results: Of the 4943 patients undergoing CABG, 908 had known cerebrovascular disease. Among these, 134 underwent concomitant CEA, and these were propensity matched with 134 patients undergoing CABG only. No differences were observed in the perioperative risks of stroke (4% vs 3%, odds ratio [OR] 1.5, 95% confidence interval [CI] 0.4-5.5), MI (0.7% vs 0.7%, not significant [NS]), or combined cardiovascular events (6% vs 10%, OR 0.5, 95% CI [0.2-1.3]), although mortality (1% vs 8%, OR 0.2, 95% CI [0.04-0.8] was higher with CABG only.
    Discussion: Addition of CEA to CABG did not significantly alter the risk of perioperative stroke relative to propensity-matched patients undergoing CABG alone.
    Mesh-Begriff(e) Aged ; Carotid Stenosis/complications ; Carotid Stenosis/mortality ; Carotid Stenosis/surgery ; Coronary Artery Bypass/adverse effects ; Coronary Artery Bypass/mortality ; Coronary Artery Disease/complications ; Coronary Artery Disease/mortality ; Coronary Artery Disease/surgery ; Endarterectomy, Carotid/adverse effects ; Endarterectomy, Carotid/mortality ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Odds Ratio ; Propensity Score ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; South Carolina ; Stroke/etiology ; Time Factors ; Treatment Outcome
    Sprache Englisch
    Erscheinungsdatum 2011-02
    Erscheinungsland United States
    Dokumenttyp Comparative Study ; Journal Article
    ZDB-ID 2076272-0
    ISSN 1938-9116 ; 1538-5744
    ISSN (online) 1938-9116
    ISSN 1538-5744
    DOI 10.1177/1538574410393752
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  10. Artikel: Prospective decision analysis modeling indicates that clinical decisions in vascular surgery often fail to maximize patient expected utility.

    Brothers, Thomas E / Cox, Montgomery H / Robison, Jacob G / Elliott, Bruce M / Nietert, Paul

    The Journal of surgical research

    2004  Band 120, Heft 2, Seite(n) 278–287

    Abstract: Background: Applied prospectively to patients with peripheral arterial disease, individualized decision analysis has the potential to improve the surgeon's ability to optimize patient outcome.: Methods: A prospective, randomized trial comparing ... ...

    Abstract Background: Applied prospectively to patients with peripheral arterial disease, individualized decision analysis has the potential to improve the surgeon's ability to optimize patient outcome.
    Methods: A prospective, randomized trial comparing Markov surgical decision analysis to standard decision-making was performed in 206 patients with symptomatic lower extremity arterial disease. Utility assessment and quality of life were determined from individual patients prior to treatment. Vascular surgeons provided estimates of probability of treatment outcome, intended and actual treatment plans, and assessment of comfort with the decision (PDPI). Treatment plans and PDPI evaluations were repeated after each surgeon was made aware of model predictions for half of the patients in a randomized manner.
    Results: Optimal treatments predicted by decision analysis differed significantly from the surgeon's initial plan and consisted of bypass for 30 versus 29%, respectively, angioplasty for 28 versus 11%, amputation for 31 versus 6%, and medical management for 34 versus 54% (agreement 50%, kappa 0.28). Surgeon awareness of the decision model results did not alter the verbalized final plan, but did trend toward less frequent use of bypass. Patients for whom the model agreed with the surgeon's initial plan were less likely to undergo bypass (13 versus 30%, P < 0.01). Greater surgeon comfort was present when the initial plan and model agreed (PDPI score 47.5 versus 45.6, P < 0.005).
    Conclusions: Individualized application of a decision model to patients with peripheral arterial disease suggests that arterial bypass is frequently recommended even when it may not maximize patient expected utility.
    Mesh-Begriff(e) Aged ; Amputation ; Angioplasty ; Arteries ; Decision Support Techniques ; Decision Trees ; Female ; Humans ; Leg/blood supply ; Male ; Markov Chains ; Middle Aged ; Patient Care Planning ; Patient Satisfaction ; Quality of Life ; Treatment Outcome ; Vascular Diseases/surgery ; Vascular Diseases/therapy ; Vascular Surgical Procedures
    Sprache Englisch
    Erscheinungsdatum 2004-08
    Erscheinungsland United States
    Dokumenttyp Clinical Trial ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2004.01.004
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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