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Quality of Life After Revascularization and Major Amputation for Lower Extremity Arterial Disease

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Handbook of Disease Burdens and Quality of Life Measures

Abstract:

Lower extremity arterial disease (LEAD) is not a curable disease and revascularization procedures have little or no effect on the overall life expectancy. Hence, treatment should be aimed primarily at alleviating symptoms, controlling risk factors and improving health-related quality of life (HRQOL). LEAD is associated with impaired HRQOL not only in physical domains but also in social function, emotional and mental health. LEAD is commonly associated with many risk factors each being capable to deteriorate HRQOL independently.

In contrast to the well-developed body of publications on surgical outcomes, prospective data on patient-oriented outcomes after revascularization are still lacking with a total volume of publications currently below 40.

The available data provide some evidence that successful revascularization immediately improves the HRQOL in patients suffering from ischemic claudication with a lasting benefit on physical functioning for at least 12 months while a trend toward return to baseline values in mental health, emotional and vitality domains is commonly observed. Surprisingly, patients with unsuccessful revascularization with minimal increase in lower limb blood flow still experience some improvement in pain, emotional reactions and family relationships in the first year. In the most severe form of LEAD (critical limb ischemia), an immediate and lasting benefit on HRQOL is seen after successful revascularization although less pronounced than in claudicants. However, despite long-term limb salvage and optimal graft functioning, patients successfully revascularized remain functionally disabled when compared to age-matched subjects, nevertheless they report similar well-being. After major limb amputation, some improvement in HRQOL can be expected through pain relief and the maintenance of mobility either with prosthetic rehabilitation or wheel chair ambulation.

The measurement of HRQOL is clearly needed at baseline and after vascular operations but its future role in the decision making process is yet to be defined.

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Abbreviations

ABI:

ankle brachial index

CLI:

critical limb ischemia

ET:

endovascular therapy

HRQOL:

health-related quality of life

IC:

intermittent claudication

LEAD:

lower extremity arterial disease

OVS:

open vascular surgery

PTA:

percutaneous transluminal angioplasty

TASC:

Trans-Atlantic Inter-Society Consensus

VBG:

venous bypass graft

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Author information

Authors and Affiliations

  1. Service de Chirurgie Vasculaire et Thoracique, University Hospital (CHU de Pointe-à-Pitre-Abymes), Guadeloupe, French West Indies

    M. Deneuville

Authors
  1. M. Deneuville
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Editor information

Editors and Affiliations

  1. Dept. Nutrition and Dietetics Nutritional Sciences Research Division School of Biomedical & Health Sciences, King's College London, Franklin‐Wilkins Building 150 Stamford Street, SE1 9NH, London, UK

    Victor R. Preedy (Prof.) (Prof.)

  2. Mel and Enid Zuckerman College of Public Health, University of Arizona, Health Science Center 1295 N. Martin, P.O. Box 245155, 85724-5155, Tucson, AZ

    Ronald R. Watson (Prof.) (Prof.)

Appendix

Appendix

Key facts of revascularization for lower extremity arterial disease

Level of disease

Type

Material

Mortality %

Indications

Expected 5-year patency %

Aorto- iliac

BPGa

Pro

3.3

Bilateral, Long aortic lesion

85–90

biAxF

Pro

7

50–76

ET

Stent

ND

<3 cm stenosis

77

Iliac arteries

ET

Stent

1

Focal stenosis

64–75

Cxo

Pro

6

Unilateral occlusion

55–92

AxF

Pro

6

44–79

CFA/bifurcation

TEA

Patch

0–3

Focal stenosis

50

PFA

TEA

Pro or Ven

SFA/ AK popliteal

BPG

Ven or Pro

1.3–6

Multiple lesions

66/50

ET

Stent if failure

0.9

Focal lesion

33–62

BK popliteal

BPG

Ven (GSV)

1.3–6

Multiple lesions

66

ET

 

ND

Focal stenosis

 

Leg/pedal

BPG

Ven (GSV)

1.3–7

Multisegmental CLI only

74–80

ET

Subintimal

ND

33–51

  1. BPG bypass graft; TEA thromboendarterectomy; ET: endovascular therapy
  2. a BPG aortobifemoral; biAxF axillo bifemoral; AxF axillofemoral; Cxo crossover BPG; AK above-knee; BK below-knee; CFA common femoral, PFA profunda femoris, SFA superficial femoral artery; GSV great saphenous vein, Pro prosthesis, Ven venous; CLI critical limb ischemia, Nd no data

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Deneuville, M. (2010). Quality of Life After Revascularization and Major Amputation for Lower Extremity Arterial Disease. In: Preedy, V.R., Watson, R.R. (eds) Handbook of Disease Burdens and Quality of Life Measures. Springer, New York, NY. https://doi.org/10.1007/978-0-387-78665-0_138

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  • DOI: https://doi.org/10.1007/978-0-387-78665-0_138

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