Abstract 4364722: Arterial Duplex Ultrasound Impacts Endovascular Outcomes: Unintended Consequences of Patient Harm From the 2023 and 2025 Amputation Reduction and Compassion Act
Bibliographic record
Abstract
Background: The Amputation Reduction and Compassion (ARC) Act of 2023 and 2025 supports arterial duplex ultrasound (DUS) as an initial screening tool to detect and treat peripheral arterial disease (PAD) to reduce amputations. Our prior research found use of DUS in PAD management was associated with higher rates of atherectomy procedures, questionable interventions, and worse surgical outcomes when compared to the use of ankle-brachial index (ABI) with toe-brachial index (TBI). Given DUS’s higher false-positive rate, we hypothesize DUS may be associated with higher vascular complications of claudication, chronic limb threatening ischemia (CLTI), major amputations, and increased endovascular intervention. If confirmed, the ARC Act’s recommendation for DUS may have unintended consequences of patient harm. Methods: Using the TriNetx de-identified database from April 2010–2025, we performed a retrospective cohort study. Inclusion criteria were: a) PAD diagnosis; b) at least one PAD risk factor (diabetes, hypertension, hyperlipidemia, smoking); c) an endovascular procedure (atherectomy, stenting, or angioplasty) performed within two years of both PAD diagnosis and PAD risk factor. Cohorts were assessed for PAD diagnosis by ABI/TBI alone (Cohort A), DUS alone (Cohort B), or both (Cohort C). After propensity score matching for age, gender, and race, we compared Cohorts A-B, A-C, and B-C, to assess for vascular complications, including chronic kidney disease/renal failure and lower extremity CTA, within five years of intervention. Results: Cohort A-B (n=9,180) displayed claudication (RR=1.334, p<0.0001) and re-interventions (RR=1.407, p<0.0001) in Cohort B. Cohort A-C (n=27,833) displayed claudication (RR=2.152, p<0.0001), CLTI (RR=1.687, p<0.0001), amputation (RR=1.286, p<0.0001), lower extremity CTA (RR=1.977, p<0.0001), and re-interventions (RR=1.817, p<0.0001) in Cohort C. Cohort B-C (n=9,683) displayed claudication (RR=1.724, p<0.0001), CLTI (RR=1.487, p<0.0001), amputation (RR=1.385, p<0.0001), lower extremity CTA (RR=1.987, p<0.0001), and re-interventions (RR=1.286, p<0.0001) in Cohort C. After excluding PAD diagnosis as a confounder, major amputation increased (RR=1.156, p<0.0072) in Cohort A. Conclusion: This is the second research group study linking DUS with increased and questionable interventions. These results highlight the risk for greater public harm if DUS is used as a screening tool, as detailed in the 2023 and 2025 ARC ACT.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".