Scope of the registry
This is a de-identified quality-improvement registry of consecutive chronic limb-threatening ischemia procedures performed at this practice. It covers the whole arterial tree we treat — from the iliac arteries in the pelvis to the arteries of the foot. Every figure on this page carries the endpoint it measures and the window it was measured in.
From January 2025 through May 2026, Dr. Comstock treated 4,125 below-the-knee lesions, including 2,551 below the ankle (in the foot), across 1,272 cases. In 785 of those cases (about 6 in 10), every treated lesion was below the knee, and in 327 (about 1 in 4), every treated lesion was below the ankle. These counts come from our de-identified procedure registry of his cases, all payers; they describe the work performed, not patient outcomes.
Per-vessel technical success
Technical success here means a residual narrowing under 50% with restored inline flow, graded per-vessel to Peripheral Academic Research Consortium (PARC) / SVS reporting standards. It is counted on the attempted denominator — every vessel we tried to treat is in the count, whether or not it succeeded, so the number is never conditioned on success. Technical success is a procedural endpoint; it is not limb salvage and not wound healing.
By arterial segment, on the attempted denominator:
ARTERIAL SEGMENT
EVALUABLE VESSELS
TECHNICAL SUCCESS
All segments
6,720
6,071 - 90.3%
Inframalleolar / pedal
3,544
3,255 - 91.8%
Tibial
2,040
1,860 - 91.2%
Femoropopliteal
1,100
925 - 84.1%
Iliac
36 evaluable (37 treated)
31 - 86.1%
Within specific technical scenarios, again on the attempted denominator:
Contrast stewardship — protecting the kidneys
Because many of the patients we treat have reduced kidney function, we track how much iodinated contrast each procedure uses, measured across every case with a recorded volume. Published safe-volume thresholds by CKD stage are shown alongside for reference.
Durability — freedom from restenosis-driven reintervention
This endpoint is freedom from a reintervention for restenosis — a repeat procedure on the same target vessel and same limb, performed because the treated segment re-narrowed. It is estimated by per-limb Kaplan–Meier analysis of 1,207 limbs (273 events).
What this is and is not. This measures reinterventions that happened. It is not imaging-based patency and not a binary restenosis rate — a vessel can narrow on imaging without a reintervention being warranted, and the two measures are not equivalent. We report the reintervention endpoint because it reflects a decision that was actually made in the care of the patient. It can only count patients who returned to care, so it is best read as a lower-bound-style estimate: restenosis in a patient who never re-presented is not captured. Numbers of limbs at risk across the year: 1,207 · 943 · 692 · 459 · 252 · 76.
What we do not yet measure
Everything above is a procedural endpoint. Several outcomes that matter just as much are not captured in this registry, and we will not claim or benchmark what we do not measure:
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Amputation-free survival — not captured.
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Limb salvage — not captured.
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Primary patency — not captured (this registry records reinterventions performed, not imaging-based patency).
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Wound healing — not captured.
A prospective wound-and-limb-outcome linkage is planned so that these can be reported to the same standard. Until then, we neither claim nor rank them.
How we image before we treat
Before we treat an artery we image it from the inside with intravascular ultrasound, so the plan is built on the vessel’s true dimensions rather than a shadow on an angiogram. This informs how a vessel is prepared and how a device is sized. How we treat PAD →
Methodology & Governance
De-identified quality-improvement registry of consecutive procedures; all patient-level computation performed on-site. Per-vessel technical success graded to Peripheral Academic Research Consortium / SVS reporting standards on the attempted denominator (never conditioned on success). Figures reflect procedural endpoints; amputation-free survival, primary patency, and wound healing are not yet captured (see ‘What we do not yet measure’).
Individual results vary. All patient-level computation is performed on-site from de-identified data.