Endoluminal Therapy in Patients with Peripheral Arterial Disease: Prospective Assessment of Quality of Life in One Hundred Ninety Patients

Abstract

Conclusion: Successful peripheral endovascular revascularization (PER) results in improved quality of life for both patients with claudication and critical limb ischemia. Summary: The authors evaluated prospectively changes in quality of life in 190 patients before PER and at 1, 3, 6, and 12 months after treatment. Quality of life was assessed using the Medical Outcomes Study Short Form-36 (SF-36). The authors evaluated the effects of PER and quality of life in both claudication and critical limb ischemia patients. The influence of lesion location, restenosis, and additional interventions on quality of life was also evaluated. Data were available in 136 patients at 6 months and in 103 patients at 12 months. Patients with technically successful primary interventions, defined as residual stenosis <30%, when compared with patients with technically unsuccessful interventions, defined as residual stenosis >30%, showed significantly lower scores for bodily pain and physical functioning at 1 month, for bodily pain at 3 months, and for bodily pain and social functioning at 6 months. Patients with restenosis, followed by successful secondary intervention, showed numerous differences in SF-36 scores at 1, 3, and 6 months compared with patients who underwent a primary intervention that was initially successful. At 12 months, patients with restenosis, followed by secondary intervention, had lower scores for vitality, mental health, and general health perception. Patients with a significant stenosis diagnosed during follow-up with no secondary intervention had lower scores for physical functioning, vitality, bodily pain, and general health perception at 1 month compared with patients without stenosis. They also had lower scores for bodily pain, general health perception at 3 months, lower scores for physical functioning and social functioning at 6 months, and lower scores for physical function, vitality, social function, and bodily pain at 12 months. Patients who had deterioration in their clinical symptoms had significantly lower scores for all SF-36 domains at 1, 3, and 6 months. They also had lower scores for all domains at 12 months, except those for role limitations due to emotional problems and social function. Follow-up examinations were performed to objectively assess stenosis in 93 patients (49%) and a significant restenosis was detected in 60.2%. In 43 cases, the restenosis was at the site of intervention, and new lesions were found in the ipsilateral leg in five cases and in the contralateral leg in eight cases. Development of restenosis was related to lower scores at 1 month in the domains of physical functioning, role limitations due to emotional problems, vitality, mental health, bodily pain, and general health perception. At 3 months, restenosis was associated with lower scores in terms of vitality, bodily pain, and general health perception. At 6 months, lower scores were observed in patients with restenosis for role limitations due to emotional problems, vitality, bodily pain, and general health perception. At 12 months, restenosis was associated with lower scores for physical functioning, vitality, mental health, social function, bodily pain, and general health perception. Patients with claudication when compared with patients with critical limb ischemia showed lower scores for physical functioning, role limitations due to physical problems, role limitations due to emotional problems, vitality, and bodily pain at baseline. At 12 months after the initial intervention, no significant difference was noted in scores between claudication patients and patients with critical limb ischemia. Comment: This study is difficult to understand. It is certainly expected that many of the peripheral interventions would eventually fail and that failure of the peripheral intervention would be associated with lower SF-36 scores in many domains. It also is understandable that patients with critical limb ischemia would have lower SF-36 scores than patients with claudication. However, it makes no sense that patients with claudication and critical limb ischemia should have similar SF-36 scores at 12 months. It is unclear whether patients with critical limb ischemia have substantially improved after their intervention or that patients with claudication substantially worsened after their intervention, or a combination of both.