Inadequate rehabilitation after multi-level revascularization as a risk factor of low quality of life

Abstract

BACKGROUND: Reconstructive surgery of multilevel lesions in peripheral atherosclerosis has been undergoing changes over the past decades. The spectrum of such interventions includes conventional, endovascular and hybrid technologies. Due to the fact that the main goal of treatment is to preserve the limb, the outcome of the surgical intervention directly affects the quality of patients life; however, there is insufficient data in the literature on the tactics of postoperative rehabilitation of patients who underwent surgery for a multilevel lesion. Randomized clinical trials aimed at studying the effectiveness of walk training and rehabilitation measures demonstrate an increase in walking distance in people with peripheral atherosclerosis against the background of controlled physical exertion.
 АIM: To assess the effect of rehabilitation program on the vital activity levels in the patients who suffered from multilevel peripheral arterial disease in a long-term period after revascularization.
 MATERIALS AND METHODS: The study included 216 patients with MPAD who underwent various lower limb revascularization, including 87 patients with hybrid interventions, 81 open surgery and 48 with endovascular interventions. The patients have been examined both in perioperative and postoperative periods as well as in a long-term period (36 months) after reconstruction. Depending on the fulfillment or non-fulfillment of the proposed rehabilitation program, such indicators as limb preservation, walking distance and quality of patients life have been evaluated in accordance with the EQ-5D questionnaire.
 RESULTS: In the early postoperative period, a decrease in the number of thrombosis of the operated segment has been registered in the group of hybrid interventions in comparison with the results in the group with open operations. In the long-term period after the operation, the use of complex rehabilitation measures allowed to reduce the number of amputations and stabilize the maximum walking distance. Walk training provided the necessary level of quality of life, which, in most cases, has been recorded in the patients who underwent hybrid interventions.
 CONCLUSIONS: The composition and fullness of rehabilitation program is a circumstance affecting long-term outcomes after reconstructive vascular interventions. The exclusion of walk training from the rehabilitation program does not allow achieving the maximum frequency of limb preservation, increasing the walking distance and improving the quality of life of patients suffering from multilevel lesion of the arteries of the lower extremities.