{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:55:13Z","timestamp":1787018113117,"version":"build-2736575974"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The risk\u2013benefit trade\u2010offs after lower\u2010extremity revascularization among older patients with chronic kidney disease remain unclear. We compared how surgical versus endovascular lower\u2010extremity revascularization associates with clinical outcomes that may be valued differently by patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We selected adults aged \u226566\u2009years with chronic kidney disease who underwent lower\u2010extremity revascularization from January 1, 2008, to December 31, 2017, with \u226512 months Medicare Parts A and B before the procedure. The primary outcome was days at home at 30, 180, and 365\u2009days after revascularization. The secondary outcome was major adverse limb events (ie, lower\u2010extremity revascularization or major amputation). We report outcomes as the difference in survived days at home and days lost due to major adverse limb events by restricted mean time lost.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among 87\u2009446 patients, 15.3% underwent surgical and 84.7% underwent endovascular revascularization. Surgical revascularization was associated with fewer days at home at 30\u2009days (difference, \u22128.4 [95% CI, \u22128.6 to \u22128.2]), 180\u2009days (difference, \u221221.2 [95% CI, \u221222.1 to \u221220.4]) and 365\u2009days (difference, \u221231.9 [95% CI, \u221233.5 to \u221230.6]) compared with endovascular. Surgical revascularization was associated with fewer days lost to major adverse limb events at 180\u2009days (difference, \u22126.9 [95% CI, \u22127.6 to \u22125.8]) and at 365\u2009days (difference, \u221217.3 [95% CI, \u221219.3 to \u221214.7]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In this study of older patients with chronic kidney disease, surgical lower\u2010extremity revascularization was associated with fewer survived days at home, but also with fewer days lost to major adverse limb events compared with an endovascular approach. Considering different risk\u2013benefit profiles when planning for lower\u2010extremity revascularization is essential to facilitate shared decision making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.048230","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T10:49:26Z","timestamp":1779706166000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Balancing Days at Home and Major Adverse Limb Events After Surgical Versus Endovascular Lower\u2010Extremity Revascularization in Chronic Kidney Disease"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4691-1681","authenticated-orcid":false,"given":"Tara I.","family":"Chang","sequence":"first","affiliation":[{"name":"Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5156-8566","authenticated-orcid":false,"given":"Gomathy","family":"Parvathinathan","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5406-5649","authenticated-orcid":false,"given":"Sai","family":"Liu","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8047-4190","authenticated-orcid":false,"given":"Jun Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Yonsei University Wonju College of Medicine","place":["Wonju, South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7246-1370","authenticated-orcid":false,"given":"Ali","family":"Etemadi","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0404-9325","authenticated-orcid":false,"given":"Shipra","family":"Arya","sequence":"additional","affiliation":[{"name":"Section of Vascular Surgery, Veterans Association Palo Alto Health Care System","place":["Palo Alto, USA"]},{"name":"Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9271-8332","authenticated-orcid":false,"given":"Margaret R.","family":"Stedman","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61249-0"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.17.2038"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(17)30183-3"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001251"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.01070905"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V132497"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.22.2666"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.01.001"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2008040349"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfn571"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfm660"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfv418"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2207899"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.065277"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.40196"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14196"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1703423"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znae278"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","unstructured":"Stanford Center for Population Health Sciences . Medicare 20% [2006\u20132018] MedPAR (Version 1.0) [Dataset]. 2021. doi: 10.57761\/nc92-5272.","DOI":"10.57761\/nc92-5272"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","unstructured":"Stanford Center for Population Health Sciences . Medicare 20% [2019\u20132020] MedPAR (Version 1.0) [Dataset]. Redivis. 2023. doi: 10.57761\/67t8-9d86.","DOI":"10.57761\/67t8-9d86"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","unstructured":"Stanford Center for Population Health Sciences . Medicare 20% [2019\u20132020] Hospice\/Home Health\/DMERC (Version 1.0) [Dataset]. Redivis. 2023. doi: 10.57761\/za2p-7050.","DOI":"10.57761\/za2p-7050"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","unstructured":"Stanford Center for Population Health Sciences . Medicare 20% [2006\u20132018] Carrier (Version 1.0) [Dataset]. Redivis. 2021. doi: 10.57761\/d1kp-xa44.","DOI":"10.57761\/d1kp-xa44"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","unstructured":"Stanford Center for Population Health Sciences . Medicare 20% [2006\u20132018] Outpatient (Version 1.0) [Dataset]. Redivis. 2021. doi: 10.57761\/qgsq-tj66.","DOI":"10.57761\/qgsq-tj66"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","unstructured":"Stanford Center for Population Health Sciences . Medicare 20% [2006\u20132018] Enrollment\/Summary (MBSF) (Version 1.0) [Dataset]. Redivis. 2021. doi: 10.57761\/wnn9-b060.","DOI":"10.57761\/wnn9-b060"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","unstructured":"Stanford Center for Population Health Sciences . Medicare 20% [2019\u20132020] Carrier (Version 1.0) [Dataset]. Redivis. 2023. doi: 10.57761\/w5a5-yb97.","DOI":"10.57761\/w5a5-yb97"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","unstructured":"Stanford Center for Population Health Sciences . Medicare 20% [2019\u20132020] Outpatient (Version 1.0) [Dataset]. Redivis. 2023. doi: 10.57761\/9ct0-kf53.","DOI":"10.57761\/9ct0-kf53"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","unstructured":"Stanford Center for Population Health Sciences . Medicare 20% [2019\u20132020] Enrollment\/Summary (Version 1.0) [Dataset]. Redivis. 2023. doi: 10.57761\/xg2t-1343.","DOI":"10.57761\/xg2t-1343"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","unstructured":"Stanford Center for Population Health Sciences . Medicare 20% [2006\u20132018] Hospice\/Home health\/DMERC (Version 1.0) [Dataset]. Redivis. 2021. doi: 10.57761\/am2m-1935.","DOI":"10.57761\/am2m-1935"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/5586060"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.2436"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199801000-00004"},{"key":"e_1_3_2_33_2","unstructured":"Bensken W. Multimorbidity: Harmonizing Various Comorbidity Multimorbidity and Frailty Measures. 2023 Accessed March 31 2026. https:\/\/cran.r\u2010project.org\/package=multimorbidity."},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3697"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-200009000-00011"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.7326\/M23-3028"},{"key":"e_1_3_2_37_2","unstructured":"Conner S. rmtl.ipcw: Inverse Probability\u2013Weighted Regression Model for Competing Risks. 2020 Accessed October 8 2025. https:\/\/github.com\/s\u2010conner\/rmtl\/blob\/master\/functions\/rmtl_ipcw_function.R."},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.8896"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glae094"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","unstructured":"Bedell D. R program \u2010 claims\u2010based frailty index. Harvard Dataverse. 2020 Accessed March 31 2026. 10.7910\/DVN\/4Y3Y23.","DOI":"10.7910\/DVN\/4Y3Y23"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.12.048"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2024.09.024"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15705"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2024.12.128"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2024.07.041"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2025.03.013"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.124.320195"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.048230","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T13:25:52Z","timestamp":1781789152000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.048230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":46,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,6,2]]}},"alternative-id":["10.1161\/JAHA.125.048230"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.048230","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]},"assertion":[{"value":"2025-11-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e048230"}}