{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T14:21:26Z","timestamp":1791037286615,"version":"4.1.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,6,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The long\u2010term effectiveness of atherectomy treatment for peripheral arterial disease is unknown. We studied 5\u2010year clinical outcomes by endovascular treatment type among patients with peripheral arterial disease.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We queried the Medicare\u2010linked VQI (Vascular Quality Initiative) registry for endovascular interventions from 2010 to 2015. The exposure was treatment type: atherectomy (with or without percutaneous transluminal angioplasty [\n              <jats:styled-content style=\"fixed-case\">PTA]<\/jats:styled-content>\n              ), stent (with or without\n              <jats:styled-content style=\"fixed-case\">PTA<\/jats:styled-content>\n              ), or\n              <jats:styled-content style=\"fixed-case\">PTA<\/jats:styled-content>\n              alone. The outcomes were major amputation, any amputation, and major adverse limb event (major amputation or any reintervention). We used the center\u2010specific proportions of atherectomy procedures performed in the 12\u00a0months before a patient's procedure as the instruments to perform an instrumental\u2010variable Cox model analysis. Among 16\u00a0838 eligible patients (median follow\u2010up: 1.3\u20131.5\u00a0years), 11% underwent atherectomy, 40% received\n              <jats:styled-content style=\"fixed-case\">PTA<\/jats:styled-content>\n              alone, and 49% underwent stenting. Patients receiving atherectomy commonly underwent femoropopliteal artery treatment (atherectomy: 65%;\n              <jats:styled-content style=\"fixed-case\">PTA<\/jats:styled-content>\n              : 49%; stenting: 43%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and had worse disease severity (Trans\u2010Atlantic Inter\u2010Society Consensus score [TASC] B and greater; atherectomy: 77%;\n              <jats:styled-content style=\"fixed-case\">PTA<\/jats:styled-content>\n              : 68%; stenting: 67%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). The 5\u2010year rate of major adverse limb events was 38% in patients receiving atherectomy versus 33% for\n              <jats:styled-content style=\"fixed-case\">PTA<\/jats:styled-content>\n              and 32% for stenting (log rank\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Controlling for unmeasured confounding using instrumental\u2010variable analysis, patients treated with atherectomy experienced outcomes similar to those of patients treated with\n              <jats:styled-content style=\"fixed-case\">PTA<\/jats:styled-content>\n              , except for a higher risk of any amputation (hazard ratio: 1.51; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 1.08\u20132.13). However, compared with stenting, atherectomy patients had a higher risk of major amputation (hazard ratio: 3.66; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 1.72\u20137.81), any amputation (hazard ratio: 2.73; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 1.60\u20134.76), and major adverse limb event (hazard ratio: 1.61; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 1.10\u20132.38).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Atherectomy is used to treat severe femoropopliteal and tibial peripheral arterial disease even though long\u2010term adverse outcomes occur more frequently after this treatment modality.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.012081","type":"journal-article","created":{"date-parts":[[2019,6,5]],"date-time":"2019-06-05T09:20:17Z","timestamp":1559726417000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":62,"title":["Adverse Events After Atherectomy: Analyzing Long\u2010Term Outcomes of Endovascular Lower Extremity Revascularization Techniques"],"prefix":"10.1161","volume":"8","author":[{"given":"Niveditta","family":"Ramkumar","sequence":"first","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice Lebanon NH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Martinez\u2010Camblor","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice Lebanon NH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse A.","family":"Columbo","sequence":"additional","affiliation":[{"name":"Section\u00a0of Vascular Surgery Department of Surgery Dartmouth\u2010Hitchcock Medical Center Lebanon NH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas H.","family":"Osborne","sequence":"additional","affiliation":[{"name":"Section\u00a0of Vascular Surgery University of Michigan Medical School Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip P.","family":"Goodney","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice Lebanon NH"},{"name":"Section\u00a0of Vascular Surgery Department of Surgery Dartmouth\u2010Hitchcock Medical Center Lebanon NH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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