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A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia
Open accessAbstract
Objectives Few centers have adopted endovascular therapy for the treatment of acute mesenteric ischemia (AMI). We sought to evaluate the effect of endovascular therapy on outcomes for the treatment of AMI.Methods A single-center, retrospective cohort review was performed on all consecutive patients with thrombotic or embolic AMI presenting between 1999 and 2008. Patients with mesenteric venous thrombosis, nonocclusive mesenteric ischemia, and ischemia associated with aortic dissection were excluded. Demographic factors, preoperative metabolic status, and etiology were compared. Primary clinical outcomes included endovascular technical success, operative complications, and in-hospital mortality.Results Seventy consecutive patients were identified with AMI (mean age, 64 ± 13 years). Etiology of mesenteric ischemia was 65% thrombotic and 35% embolic occlusions. Endovascular revascularization was the preferred treatment (81%) vs operative therapy (19%). Successful endovascular treatment was achieved in 87%. Endovascular therapy required laparotomy in 69% vs traditional therapy in 100% (P < .05), with a median 52-cm necrotic bowel resected (interquartile range [IQR], 11-140 cm) vs 160 cm (IQR, 90-250 cm; P < .05), respectively. Acute renal failure and pulmonary failure occurred less frequently with endovascular therapy (27% vs 50%; P < .05 and 27% vs 64%; P < .05). Successful endovascular treatment resulted in a mortality rate of 36% compared with 50% (P < .05) with traditional therapy, whereas the mortality rate for endovascular failures was 50%. Endovascular therapy was associated with improved mortality in thrombotic AMI (odds ratio, 0.10; 95% confidence interval, 0.10-0.76; P < .05).Conclusions Endovascular therapy has altered the management of AMI, and there are measurable advantages to this approach. Using endovascular therapy as the primary modality for AMI reduces complications and improves outcomes.
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“riod, the maximum lactate level and necrotic bowel requiring resection also negatively affected overall mortality.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
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In the paper
“This subgroup group did not experience any risk of death greater than those who underwent traditional therapy.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
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In the paper
“Successful endovascular treatment was achieved in 87%.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Abstract
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In the paper
“endovascular failures approached the mortality rate of traditional therapy (50% vs 50%).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
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In the paper
“In the postoperative period, acute renal failure and pulmonary failure were significantly associated with death.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
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In the paper
“Duration of symptoms did not correlate with technical success (median, 36; IQR, 16-130 hours) compared with failures (median, 48; IQR, 24-84 hours; P ϭ .20).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
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In the paper
“The overall mortality was 39% for endovascular therapy vs 50% for traditional therapy (P ϭ .10).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
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In the paper
“Endovascular therapy required laparotomy in 69% vs traditional therapy in 100% (P < .05)”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Abstract
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In the paper
“An evaluation of factors associated with endovascular success found no differences in thrombotic (89%) vs embolic disease (85%; P ϭ .94)or in proximal occlusions (85%) vs distal occlusions (93%; P ϭ .79).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
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In the paper
“At the time of presentation, increasing age, history of coronary artery disease, peripheral arterial disease, and initial lactate Ͼ2.2 mmol/L were associated with increased risk of death.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In this series, patients treated with endovascular therapy presented with a median of 62 hours of symptoms, which was much longer than those undergoing traditional therapy.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
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In the paper
“No measurable deleterious effects of endovascular therapy were identified within this cohort.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
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In the paper
“Overall, endovascular therapy was not associated with a survival benefit.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“At the time of presentation, increasing age, history of coronary artery disease, peripheral arterial disease, and initial lactate Ͼ2.2 mmol/L were associated with increased risk of death.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Acute renal failure and pulmonary failure occurred less frequently with endovascular therapy (27% vs 50%; P < .05 and 27% vs 64%; P < .05).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“At the time of presentation, increasing age, history of coronary artery disease, peripheral arterial disease, and initial lactate Ͼ2.2 mmol/L were associated with increased risk of death.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Postoperative complications occurred more frequently with traditional therapy (Table III).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
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In the paper
“Despite these differences, the etiology of occlusion did not affect the mortality rate in our population.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Procedural time for endovascular revascularization was essentially identical to traditional therapy.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the postoperative period, acute renal failure and pulmonary failure were significantly associated with death.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“During the 9-year study period, 70 patients with AMI secondary to thrombotic or embolic arterial occlusions were treated.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“however, endovascular therapy significantly reduced the mortality for thrombotic occlusions (mortality, 33%; odds ratio, 0.10; 95% confidence interval, 0.17-0.76;P Ͻ .05)compared with traditional therapy (mortality, 83%).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“An evaluation of factors associated with endovascular success found no differences in thrombotic (89%) vs embolic disease (85%; P ϭ .94)or in proximal occlusions (85%) vs distal occlusions (93%; P ϭ .79).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Duration of symptoms before treatment was markedly longer in the patients treated with endovascular therapy (median, 62 vs 26 hours; P Ͻ .05).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“31% of patients treated with endovascular therapy avoided laparotomy altogether.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients who were successfully treated with endovascular therapy experienced a significant reduction in mortality (36%) compared with traditional therapy (50%; P Ͻ .05).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Duration of abdominal symptoms also did not affect the likelihood of endovascular success.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Acute renal failure and pulmonary failure occurred less frequently with endovascular therapy (27% vs 50%; P < .05 and 27% vs 64%; P < .05).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“At the time of presentation, increasing age, history of coronary artery disease, peripheral arterial disease, and initial lactate Ͼ2.2 mmol/L were associated with increased risk of death.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“riod, the maximum lactate level and necrotic bowel requiring resection also negatively affected overall mortality.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The technical success for partial occlusions was 100% compared with 82% for complete occlusions (P ϭ .18).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Subgroup analysis demonstrated that there was no significant difference in mortality for embolic occlu-sions for endovascular therapy (53%) vs traditional therapy (33%; P ϭ .20);”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Load-bearingStrength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Eighty-one percent of the patients were chosen to undergo endovascular therapy first.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Sean P. Roddy (Albany, NY
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Their laparotomy rate was around 68% to 72% in all of those subgroups.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Sean P. Roddy (Albany, NY
Strength:plain· not yet calibratedn = 56Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All of these factors were associated with a lower mortality rate in this group.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Disparities in etiologies across the two groups are partially attributable to progression in the treatment paradigm at our institution.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Strength:plain· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“to date, this study represents the largest series of patients with AMI treated with endovascular therapy.”
- Also stated in: § DISCUSSION · plain
“This represents the largest single-center experience using endovascular therapy for the treatment of AMI.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: Acute mesenteric ischemia is relatively infrequent, making it difficult for a single center to accumulate a large experience in a short period.
- Also stated in: § DISCUSSION · plain
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These results can be explained by the variability in abdominal pain in relationship to tolerance of intestinal ischemia, prior visceral atherosclerosis, degrees of collater-”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Our results contradict previous reports demonstrating duration of abdominal pain portending a worse prognosis.5,13”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
What the sources say
- Not checked yetcites [5] Kassahun, 2008, Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review, Langenbecks Arch Surg source
- Not checked yetcites [13] Acosta, 2005, Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients, Ann Surg source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“The mortality rate was 17% in the hybrid group compared with 80% in the patients treated with open revascularization during the same period.12”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
What the sources say
- Not checked yetcites [12] Wyers, 2007, Retrograde mesenteric stenting during laparotomy for acute occlusive mesenteric ischemia, J Vasc Surg source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Previous case reports and small series that report mortality rates of 0% to 17% 10,12 for endovascular therapy are largely subject to reporting bias.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesWhat the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The classification of etiology relied on surgeon interpretation of the clinical presentation, radiographic findings, and operative findings, subjecting this variable to error.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Rests on an assumption: The variability and error in determining exact etiology is uniform across articles reporting outcomes for acute mesenteric ischemia.
In the paper
“The largest series available for open retrograde stenting in the setting of AMI involved six patients.12”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
What the sources say
- Not checked yetcites [12] Wyers, 2007, Retrograde mesenteric stenting during laparotomy for acute occlusive mesenteric ischemia, J Vasc Surg source
Strength:plain· not yet calibratedn = 6Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesWhat the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The current report offers a complete representation of all consecutive patients treated with AMI during the past 9 years at a large multidisciplinary referral center”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesWhat the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Examining all measurable covariates, we couldn't differentiate any specific reasons for bias other than surgeon preference.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Sean P. Roddy (Albany, NY
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“successful endovascular therapy portends a survival advantage in this moribund population.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > CONCLUSIONS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- It may state two separate claims as one. 34
- Probably not a substantial claim. 27
- The quote only partly states this claim. 1
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, the endovascular cohort was weighted with more thrombotic occlusions (72%) compared with the traditional cohort, which was weighted with more embolic occlusions (64%).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Endovascular failures resulted in a 50% mortality rate, similar to traditional therapy.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Endovascular therapy was initiated in 56 patients (81%), representing the preferred treatment modality for acute mesenteric ischemia during this 9-year period.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedn = 56Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was a 9% initial endovascular failure rate in this series, with a total failure rate of 13%, resulting in an 87% technical success rate for endovascular therapy.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although endovascular failures did not increase the mortality rate, endovascular successes reduced the mortality rate to 36% from 50%.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the current series, patients undergoing endovascular therapy presented with a median of 60 hours of abdominal pain, and duration of symptoms Ͻ24 hours was only weakly associated with death.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although not statistically significant, those with traditional therapy tended to have a slightly higher lactate concentration on admission (median, 3.5 mmol/L) compared with endovascular therapy (median, 2.3 mmol/L; P ϭ .06).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Taken into historical context, the endovascular group was weighted with thrombotic occlusions (72% of patients) yet resulted in the lowest subgroup mortality (33%).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“computed tomography angiography was used in essentially all patients to secure the diagnosis, and arteriography was primarily used with endovascular treatment.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The etiology was thrombotic occlusion in 65% compared with embolic occlusion in 35%.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedn = 70Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients treated with endovascular therapy were slightly older (65 Ϯ 12 vs 60 Ϯ 13 years; P Ͻ .05).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The mean age of the population was 64 Ϯ 13 years.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Strength:plain· not yet calibratedn = 70Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the resultant mortality rate was 36% for successful endovascular therapy compared with 50% for failures.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“of those requiring bowel resection, a median of 52 cm of bowel was resected compared with 160 cm for traditional therapy (P Ͻ .05).”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > RESULTS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The age difference, although statistically significant, is clinically negligible.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Initially, thrombotic arterial occlusions were first approached with endovascular therapy, followed by embolic occlusions as experience matured; therefore, a larger percentage of thrombotic occlusions were treated with endovascular therapy.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The bleeding complications were relatively low: These patients did not experience hemorrhagic stroke, gastrointestinal bleeding was minor, and accessrelated bleeding was 9%.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Endovascular therapy afforded lower laparotomy rates, a significantly smaller bowel resection at the time of surgical exploration, and lower rates of renal and pulmonary failure.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although selection bias is evident in this retrospective analysis, there were few measurable differences in patients treated with endovascular therapy compared with traditional therapy.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Endovascular failures were not associated with etiology or location of occlusion, but complete occlusions appeared to have a lower success rate than partial occlusions.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The 50% mortality of traditional therapy in our population is comparable to the mortality rate of 52% to 70% in recent reports, 1,5,11”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
What the sources say
- Not checked yetcites [1] Schoots, 2004, Systematic review of survival after acute mesenteric ischaemia according to disease aetiology, Br J Surg source
- Not checked yetcites [5] Kassahun, 2008, Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review, Langenbecks Arch Surg source
- Not checked yetcites [11] Cho, 2002, Long-term outcome after mesenteric artery reconstruction: a 37-year experience, J Vasc Surg source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When we examined the mortality for those patients, there is a trend for worse outcomes if they undergo infusion therapy longer.These subgroups are really too small to draw any conclusions; however, the mortality is 40% to 45%.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Sean P. Roddy (Albany, NY
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the embolectomy patients appear to have a higher mortality.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Sean P. Roddy (Albany, NY
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Our median time to laparotomy was 4 hours; therefore, most of these patients are revascularized with endovascular techniques at the time of their initial laparotomy.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Sean P. Roddy (Albany, NY
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The only aspect that really made the two groups disparate was the etiology.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Sean P. Roddy (Albany, NY
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The majority of our patients received 1 day of therapy, and then there are about seven patients that received 2 or more days of infusion therapy.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Sean P. Roddy (Albany, NY
Strength:plain· not yet calibratedn = 7Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Most of these patients remain extubated.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Arthurs.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“56 patients underwent endovascular therapy altogether, 48%, or 28 patients, underwent lytic therapy.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Sean P. Roddy (Albany, NY
Strength:plain· not yet calibratedn = 56Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“they are also the ones that presented in the shortest amount of time and with the least amount of collateralization.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Sean P. Roddy (Albany, NY
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Acute mesenteric ischemia (AMI) accounts for only 0.1% of hospital admissions but is associated with a daunting mortality rate. 1”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Abstract
What the sources say
- Not checked yetcites [1] Schoots, 2004, Systematic review of survival after acute mesenteric ischaemia according to disease aetiology, Br J Surg source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The number of vessels occluded, location of vessel occlusion, complete vs partial occlusion, and intraoperative adjuncts were based on the operating surgeon's dictation.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > METHODS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“these patients represent a cohort that was appropriately diagnosed with AMI”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
- The authors state this as an assumption: There are unidentified cases of acute mesenteric ischemia in which the vascular surgery service did not evaluate the patient.
None of the sources cited for this claim have been checked yet.
In the paper
“Endovascular therapy has been reported for the treatment of AMI in the form of case reports and case series; these initial results demonstrate feasibility, but the overall effect on outcomes is largely unknown.9,10”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Abstract
What the sources say
- Not checked yetcites [9] Yang, 2010, Successful recanalization of acute superior mesenteric artery thrombotic occlusion with primary aspiration thrombectomy, World J Gastroenterol source
- Not checked yetcites [10] Schoots, 2005, Thrombolytic therapy for acute superior mesenteric artery occlusion, J Vasc Interv Radiol source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Duration of abdominal pain did not discriminate patients who would benefit from endovascular therapy nor did it identify patients in whom endovascular therapy was prohibitive.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The determination of etiology (thrombotic or embolic) was based on the operative dictation of treatment.The classification of etiology was based on surgeon interpretation of the clinical presentation, the radiographic findings, and the operative findings; therefore, the etiology of occlusion should be interpreted in this context.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > METHODS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Given the small number of patients, we did not believe that multivariate modeling would be appropriate.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Endovascular therapy has altered the management of AMI, and there are measurable advantages to this approach.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The endovascular and traditional treatment groups are comparable enough that the observed differences in outcomes can be attributed to the treatment modality rather than to confounding by baseline characteristics.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A randomized trial for this disease process would be challenging, given the relatively infrequent occurrence and acute presentation.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
- Rests on an assumption: Acute mesenteric ischemia is relatively infrequent, making it difficult for a single center to accumulate a large experience in a short period.
In the paper
“Thrombotic occlusions are typically associated with a higher mortality (70%) compared with embolic occlusions (54%), presumably due to the large volume of bowel subjected to ischemia. 1”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
What the sources say
- Not checked yetcites [1] Schoots, 2004, Systematic review of survival after acute mesenteric ischaemia according to disease aetiology, Br J Surg source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“A single-institutional procedural database was queried for all consecutive cases of AMI treated from December 1999 to December 2008.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > METHODS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Using endovascular therapy as the primary modality for AMI reduces complications and improves outcomes.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The endovascular and traditional treatment groups are comparable enough that the observed differences in outcomes can be attributed to the treatment modality rather than to confounding by baseline characteristics.
None of the sources cited for this claim have been checked yet.
In the paper
“Contemporary results report mortality ranges of 60% to 90%, 2 and the mortality rate has remained fairly constant during the past decade, with little improvement in results.[3][4][5]”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Abstract
What the sources say
- Not checked yetcites [2] Bradbury, 1995, Mesenteric ischaemia: a multidisciplinary approach, Br J Surg source
- Not checked yetcites [3][4][5]
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Multivariate analysis was not used secondary to the overall low number of observed cases within each group.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > METHODS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Avoiding urgent laparotomy may limit the secondary injury after the initial ischemic insult.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Initial endovascular revascularization may limit the initial ischemic insult and allow appropriate clinical resuscitation before surgical exploration.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This study was an institutional review board-approved study evaluating current therapy for AMI.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > METHODS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Computed tomography angiography affords the surgeon the opportunity to use endovascular therapy before laparotomy and also allows the clinician to assess the abdominal contents.14”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
What the sources say
- Not checked yetcites [14] Shih, 2007, CTA and MRA in mesenteric ischemia, AJR Am J Roentgenol source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Surgeon selection bias cannot be avoided.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, endovascular revascularization could potentially restore bowel perfusion more rapidly than open visceral exposure, surgical embolectomy, or surgical bypass grafting.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients with thrombotic or embolic etiologies for AMI were included.Patients presenting with AMI secondary to the following conditions were excluded: mesenteric venous thrombosis, nonocclusive mesenteric ischemia, aortic dissections complicated by visceral ischemia, and visceral ischemia occurring as part of an investigational device exemption protocol.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > METHODS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“I think that avoiding the insult of the laparotomy does give the opportunity to spare more bowel.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Sean P. Roddy (Albany, NY
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Using endovascular therapy as the primary modality for AMI reduces the need for laparotomy, reduces length of bowel resection, and limits acute renal and pulmonary failure.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > CONCLUSIONS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“I think that endovascular therapy is just as good as open therapy.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > Dr Sean P. Roddy (Albany, NY
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Endovascular therapy has altered the management of AMI, and there are measurable advantages to this approach.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > CONCLUSIONS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“this report affords details such as diagnostics, laboratory analysis, operative management, length of bowel resection, and postoperative complications that cannot be retrieved from large national databases.”
§ A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
The paper relies on this without support.
The endovascular and traditional treatment groups are comparable enough that the observed differences in outcomes can be attributed to the treatment modality rather than to confounding by baseline characteristics.
“Multivariate analysis was not used secondary to the overall low number of observed cases within each group.”
“Using endovascular therapy as the primary modality for AMI reduces complications and improves outcomes.”
The paper relies on this without support.
Acute mesenteric ischemia is relatively infrequent, making it difficult for a single center to accumulate a large experience in a short period.
“given the relative infrequency of this disease, it is difficult for any one center to obtain a large experience over a relatively short interval.”
The authors state this as an assumption.
There are unidentified cases of acute mesenteric ischemia in which the vascular surgery service did not evaluate the patient.
“presumably, there are unidentified cases of AMI in which the vascular surgery service did not evaluate the patient.”
The paper relies on this without support.
The variability and error in determining exact etiology is uniform across articles reporting outcomes for acute mesenteric ischemia.
“However, the variability and error associated with determining the exact etiology is uniform across articles reporting outcomes for AMI.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Some studies have shown that endovascular therapy is associated with lower rates of mortality and bowel resection than the traditional, open approach [11–13].”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [13]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“All studies have shown a benefit for endovascular therapy compared to open surgery in terms of lower bowel resection rates and lower 30-day mortality rates.”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [13]
Experimental — accuracy not yet measuredIn the citing paper
“a recent single-institution publication from the Cleveland Clinic by Arthurs et al 4 in which 56 of 70 patients with AMI underwent initial endovascular treatment.The group demonstrated a high success rate with only nine of 56 treatment failures and a lower in-hospital mortality rate with endovascular treatment of AMI compared to traditional open surgical treatment (36% vs 50%; P Ͻ .05).”
From Revascularization for acute mesenteric ischemia (2012) · cites this paper as [4]
In the citing paper
“Over the last decade, the use of endovascular therapy for treatment of patients with AMI has escalated dramatically at most institutions and has been associated with lower mortality than traditional open surgical therapy.4,5”
From Revascularization for acute mesenteric ischemia (2012) · cites this paper as [4]
In the citing paper
“Moreover, arteriosclerotic occlusions were associated with higher mortality compared to embolic occlusions (53% vs. 34%; P = 0.11), probably due to a larger and more poorly compensated bowel ischemia [1, 11].”
From Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a laparotomy (2023) · cites this paper as [11]
In the citing paper
“Moreover, arteriosclerotic occlusions were associated with higher mortality compared to embolic occlusions (53% vs. 34%; P = 0.11), probably due to a larger and more poorly compensated bowel ischemia [1, 11].”
From Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a laparotomy (2023) · cites this paper as [11]
In the citing paper
“Our findings in perioperative course associated with mortality are consistent with other published studies despite the fact that only patients in clinically advanced stages with indication for laparotomy were included [8–11, 14, 25, 26].”
From Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a laparotomy (2023) · cites this paper as [11]
In the citing paper
“As with other authors in recent years, an increase in arteriosclerotic occlusions to the main etiology was also observed in our study (49%) [11, 17].”
From Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a laparotomy (2023) · cites this paper as [11]
In the citing paper
“In fact, only arteriosclerotic occlusions were treated by ET so that the endovascular failure can be explained by the heavily calcified visceral aortas and mesenteric vessel orifices [11, 23].”
From Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a laparotomy (2023) · cites this paper as [11]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Renal-failure significance differs between abstract and table
MajorThe abstract reports P < .05 for the 27% versus 50% acute renal failure comparison, while Table III reports P = .14 for the same comparison.
“Acute renal failure and pulmonary failure occurred less frequently with endovascular therapy (27% vs 50%; P < .05 and 27% vs 64%; P < .05).”
“Acute renal failure, % 27 50 .14Pulmonary failure, % 27 64 Ͻ.05”
Overall mortality comparison has two P values
MinorThe Results text gives P = .10 for the 39% versus 50% mortality comparison, whereas Table III gives P = .15.
“The overall mortality was 39% for endovascular therapy vs 50% for traditional therapy (P ϭ .10).”
“Mortality, % 39 50 .15”
Confidence-interval lower bounds differ
MinorFor the thrombotic AMI mortality odds ratio of 0.10, the abstract gives a confidence-interval lower bound of 0.10, but the Results section gives 0.17. The latter interval also excludes the reported point estimate.
“Endovascular therapy was associated with improved mortality in thrombotic AMI (odds ratio, 0.10; 95% confidence interval, 0.10-0.76;P < .05).”
“endovascular therapy significantly reduced the mortality for thrombotic occlusions (mortality, 33%; odds ratio, 0.10; 95% confidence interval, 0.17-0.76;P Ͻ .05)”
Lytic-therapy count and percentage disagree
MinorThe discussion says 28 of 56 endovascular patients received lytic therapy. That is 50%, not the stated 48%.
Reported 48 · recomputed 50
“56 patients underwent endovascular therapy altogether, 48%, or 28 patients, underwent lytic therapy.”
Extended-infusion count conflicts with duration percentages
MinorThe Results section says 36% received two days of infusion and 5% received three days-about 11 of the approximately 27-28 lytic-therapy patients. The discussion instead says about seven received two or more days.
“Duration of thrombolysis infusion was most commonly 1 day (58%), with 36% of patients receiving 2 days, and 5% receiving 3 days of infusion.”
“The majority of our patients received 1 day of therapy, and then there are about seven patients that received 2 or more days of infusion therapy.”
Citations
Cites
Systematic review of survival after acute mesenteric ischaemia according to disease aetiology
Schoots, I. G., Koffeman, G. I., Legemate, D. A., Levi, M., & van Gulik, T. M. (2004) · Journal of British Surgery · doi:10.1002/bjs.4459 · Cited by 502
Chronic mesenteric ischemia: open surgery versus percutaneous angioplasty and stenting
Kasirajan, K., O'Hara, P. J., Gray, B. H., Hertzer, N. R., Clair, D. G., Greenberg, R. K., Krajewski, L. P., Beven, E. G., & Ouriel, K. (2001) · Journal of Vascular Surgery · doi:10.1067/mva.2001.111808 · Cited by 275
Self-citationUnchanged high mortality rates from acute occlusive intestinal ischemia: six year review
Kassahun, W. T., Schulz, T., Richter, O., & Hauss, J. (2008) · Langenbeck's Archives of Surgery · doi:10.1007/s00423-007-0263-5 · Cited by 262
Mesenteric ischaemia: A multidisciplinary approach
Bradbury, A. W., Brittenden, J., McBride, K., & Ruckley, C. V. (1995) · Journal of British Surgery · doi:10.1002/bjs.1800821105 · Cited by 239
The clinical course of asymptomatic mesenteric arterial stenosis
Thomas, J. H., Blake, K., Pierce, G. E., Hermreck, A. S., & Seigel, E. (1998) · Journal of Vascular Surgery · doi:10.1016/s0741-5214(98)70263-0 · Cited by 231
Retrograde mesenteric stenting during laparotomy for acute occlusive mesenteric ischemia
Wyers, M. C., Powell, R. J., Nolan, B. W., & Cronenwett, J. L. (2007) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2006.10.047 · Cited by 165
Acosta, S., Ögren, M., Sternby, N.-H., Bergqvist, D., & Björck, M. (2005) · Annals of Surgery · doi:10.1097/01.sla.0000154269.52294.57 · Cited by 162
Failure to improve outcome in acute mesenteric ischaemia: seven-year review
Mamode, I. P. (1999) · The European Journal of Surgery · doi:10.1080/110241599750007054 · Cited by 154
Thrombolytic therapy for acute superior mesenteric artery occlusion
Schoots, I. G., Levi, M. M., Reekers, J. A., Lameris, J. S., & van Gulik, T. M. (2005) · Journal of Vascular and Interventional Radiology · doi:10.1097/01.rvi.0000141719.24321.0b · Cited by 152
Long-term outcome after mesenteric artery reconstruction: a 37-year experience
Cho, J.-S., Carr, J. A., Jacobsen, G., Shepard, A. D., Nypaver, T. J., & Reddy, D. J. (2002) · Journal of Vascular Surgery · doi:10.1067/mva.2002.118593 · Cited by 145
Flagged first, then by citations
1 of the 15 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Aboyans, V., Ricco, J.-B., Bartelink, M.-L. E. L., Björck, M., Brodmann, M., Cohnert, T., Collet, J.-P., Czerny, M., De Carlo, M., Debus, S., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehx095 · Cited by 3,293
Editor's Choice – Management of the Diseases of Mesenteric Arteries and Veins
Björck, M., Koelemay, M., Acosta, S., Bastos Goncalves, F., Kölbel, T., Kolkman, J. J., Lees, T., Lefevre, J. H., Menyhei, G., Oderich, G., et al. (2017) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2017.01.010 · Cited by 658
Halliday, A. W., & Bax, J. J. (2018) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2018.03.004 · Cited by 660
Clair, D. G., & Beach, J. M. (2016) · New England Journal of Medicine · doi:10.1056/nejmra1503884 · Cited by 589
Self-citationAcute mesenteric ischemia: guidelines of the World Society of Emergency Surgery
Bala, M., Kashuk, J., Moore, E. E., Kluger, Y., Biffl, W., Gomes, C. A., Ben-Ishay, O., Rubinstein, C., Balogh, Z. J., Civil, I., et al. (2017) · World Journal of Emergency Surgery · doi:10.1186/s13017-017-0150-5 · Cited by 574
“There are no randomized controlled trials comparing laparotomy versus endovascular treatment as a first line strategy for the management AMI [10, 58, 59].”
Method
Metadata
- Authors
- Arthurs, Z. M., Titus, J., Bannazadeh, M., Eagleton, M. J., Srivastava, S., Sarac, T. P., & Clair, D. G.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Arthurs, Zachary M.
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 53
- Issue
- 3
- Pages
- 698-705
- ISSN
- 0741-5214 (ISSN-L)
- OpenAlex
- W2146977838
- Cited by
- 285
- References
- 15
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 13 · 2023: 23 · 2022: 14 · 2021: 16 · 2020: 19 · 2019: 25 · 2018: 19 · 2017: 29 · 2016: 18 · 2015: 26 · 2014: 21 · 2013: 19 · 2012: 10
- FWCI
- 17.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Keywords
- acute mesenteric ischemia, endovascular revascularization, mesenteric artery occlusion, bowel resection, in-hospital mortality, acute kidney injury, respiratory failure, surgical treatment
- MeSH terms
- Aged, Angioplasty, Balloon, Embolism, Female, Humans, Ischemia, Male, Mesenteric Vascular Occlusion, Middle Aged, Ohio, Respiratory Insufficiency, Retrospective Studies, Risk Factors, Thrombosis, Time Factors, Vascular Diseases, Vascular Surgical Procedures, Thrombolytic Therapy, Chi-Square Distribution, Odds Ratio, Treatment Outcome, Hospital Mortality, Embolectomy, Thrombectomy, Risk Assessment, Endovascular Procedures, Vascular Grafting, Acute Kidney Injury, Mesenteric Ischemia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-01, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-01 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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