{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T09:06:40Z","timestamp":1793437600301,"version":"4.5.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2013,11,18]]},"abstract":"\n Background<\/jats:title>\n \n Patients with peripheral arterial disease often experience treatment failure from restenosis at the site of a prior peripheral endovascular intervention (\n PVI<\/jats:styled-content>\n ) or lower extremity bypass (\n LEB<\/jats:styled-content>\n ). The impact of these treatment failures on the utilization and outcomes of secondary interventions is poorly understood.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n In our regional vascular quality improvement collaborative, we compared 2350 patients undergoing primary infrainguinal\n LEB<\/jats:styled-content>\n with 1154 patients undergoing secondary infrainguinal\n LEB<\/jats:styled-content>\n (\n LEB<\/jats:styled-content>\n performed after previous revascularization in the index limb) between 2003 and 2011. The proportion of patients undergoing secondary\n LEB<\/jats:styled-content>\n increased by 72% during the study period (22% of all\n LEBs<\/jats:styled-content>\n in 2003 to 38% in 2011,\n P<\/jats:italic>\n <0.001). In\u2010hospital outcomes, such as myocardial infarction, death, and amputation, were similar between primary and secondary\n LEB<\/jats:styled-content>\n groups. However, in both crude and propensity\u2010weighted analyses, secondary\n LEB<\/jats:styled-content>\n was associated with significantly inferior 1\u2010year outcomes, including major adverse limb event\u2010free survival (composite of death, new bypass graft, surgical bypass graft revision, thrombectomy\/thrombolysis, or above\u2010ankle amputation; Secondary LEB MALE\u2010free survival\u00a0=\u00a061.6% vs primary LEB MALE\u2010free survival\u00a0=\u00a067.5%,\n P<\/jats:italic>\n =0.002) and reintervention or amputation\u2010free survival (composite of death, reintervention, or above\u2010ankle amputation; Secondary LEB RAO\u2010free survival\u00a0=\u00a058.9% vs Primary LEB RAO\u2010free survival 64.1%,\n P<\/jats:italic>\n =0.003). Inferior outcomes for secondary\n LEB<\/jats:styled-content>\n were observed regardless of the prior failed treatment type (\n PVI<\/jats:styled-content>\n or\n LEB<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In an era of increasing utilization of\n PVI<\/jats:styled-content>\n , a growing proportion of patients undergo\n LEB<\/jats:styled-content>\n in the setting of a prior failed\n PVI<\/jats:styled-content>\n or surgical bypass. When caring for patients with\n peripheral arterial disease<\/jats:styled-content>\n , physicians should recognize that first treatment failure (\n PVI<\/jats:styled-content>\n or\n LEB<\/jats:styled-content>\n ) affects the success of subsequent revascularizations.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.113.000345","type":"journal-article","created":{"date-parts":[[2013,11,26]],"date-time":"2013-11-26T04:03:29Z","timestamp":1385438609000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":53,"title":["Growing Impact of Restenosis on the Surgical Treatment of Peripheral Arterial Disease"],"prefix":"10.1161","volume":"2","author":[{"given":"Douglas W.","family":"Jones","sequence":"first","affiliation":[{"name":"Department of Surgery, New York Presbyterian Hospital, Weill\u2010Cornell Medical Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andres","family":"Schanzer","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Section of Vascular Surgery, Dartmouth\u2010Hitchcock Medical Center, Lebanon, NH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd A.","family":"MacKenzie","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian W.","family":"Nolan","sequence":"additional","affiliation":[{"name":"Section of Vascular Surgery, Dartmouth\u2010Hitchcock Medical Center, Lebanon, NH"},{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Conte","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip P.","family":"Goodney","sequence":"additional","affiliation":[{"name":"Section of Vascular Surgery, Dartmouth\u2010Hitchcock Medical Center, Lebanon, NH"},{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"The Vascular Study Group of New 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