Journal of vascular surgery
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Vascular surgery has traditionally relied on prospective, randomized clinical trials, case-control series from single institutions of excellence, and case studies to guide clinical decision-making. However, the use of a number of new clinical research tools has allowed the vascular surgeon to more critically assess the indications for particular operations, the costs of various procedures from both a monetary and quality-of-life standpoint, and the "real world" outcomes that can be expected from practitioners across the United States, not just from centers of excellence. Decision analysis with modeling of cohorts with desired characteristics and vascular disease has allowed for the objective determination of procedural cost-effectiveness and evaluation of patient quality-of-life issues surrounding vascular procedures. ⋯ Importantly, the body of literature generated using these new clinical research tools is being monitored by insurers and patients, as well as by the surgeons providing the care. This ultimately will have a direct impact on practice and referral patterns. It is therefore mandatory that vascular surgeons understand these new tools so that we can police our own practices before others, such as insurance companies and hospital administrators, do it for us.