Subjective evidence evaluation survey for many-analysts studies.

Many-analysts studies explore how well an empirical claim withstands plausible alternative analyses of the same dataset by multiple, independent analysis teams. Conclusions from these studies typically rely on a single outcome metric (e.g. effect size) provided by each analysis team. Although informative about the range of plausible effects in a dataset, a single effect size from each team does not provide a complete, nuanced understanding of how analysis choices are related to the outcome. We used the Delphi consensus technique with input from 37 experts to develop an 18-item subjective evidence evaluation survey (SEES) to evaluate how each analysis team views the methodological appropriateness of the research design and the strength of evidence for the hypothesis. We illustrate the usefulness of the SEES in providing richer evidence assessment with pilot data from a previous many-analysts study.

Value of cutting balloon angioplasty for limb salvage in patients with obstruction of popliteal and distal arteries.

Popliteal-to-distal bypass is still the gold standard for limb salvage. However, some patients, especially elderly or diabetic patients, are not eligible for such treatment; and problems may arise, including poor healing of distal surgical wounds, delayed resumption of ambulation, and prolonged hospitalization. This prospective multicenter study carried out on an intent-to-treat basis includes 53 extremities in 48 patients presenting critical ischemia due to infrageniculate arterial lesions with no proximal lesions. Two populations were isolated: diabetic patients (56.6%) and elderly patients over 80 years (45%). In 82% of cases the arterial lesions were long, i.e., more than 1 cm. The limb salvage rate at 1 year was 81%. Postoperative mortality was 9%, and mortality at 1 year was 22.6%. These results show that cutting balloon angioplasty can be proposed as primary treatment in patients with critical ischemia due to popliteal and distal artery lesions.

Treatment of infrarenal aortic aneurysm by minimally invasive retroperitoneal approach: use of a video-assisted technique.

We propose a technique for treating abdominal aortic aneurysm in which first a minilaparotomy (retroperitoneal) is performed to make a conventional arterial dissection; then, video assistance is used to control the left lumbar arteries and to make the aortic anastomosis. This technique can be performed with no significant laparoscopic capability.The patient was installed in a 20-degree right lateral decubitus. A transverse left 8- to 10-cm abdominal incision was made, followed by separation of the muscular structures. Retroperitoneal control of the proximal aortic neck and of both common iliac arteries was obtained by digital and instrumental dissection. A 30-degree laparoscope was then introduced through a 8- to 12-mm trocar and provided the light and magnification that facilitated the dissection of the posterior wall of the aortic neck and of the left flank of the aneurysm, looking for the lumbar arteries to be clipped. A suspended running suture to make the aorto-prosthetic anastomosis was facilitated by the magnification of the camera, especially during the passage of needles. Between March and September 2001, 32 patients fulfilled the anatomic conditions: an infrarenal aortic neck length of 2 cm or more, absence of hypogastric artery aneurysm, and no need for inferior mesenteric artery reimplantation. In 30 patients, the surgery was performed by using the planned minimally invasive approach, and extension of the incision was necessary in two patients.