Print this pageOne Year Prospective Quality of Life Outcomes in Patients treated with Angioplasty for Symptomatic Peripheral Arterial Disease
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Corey A. Kalbaugh, MS, Spence M. Taylor, Sr., MD, Mark R. Jackson, MD, Dawn W. Blackhurst, DrPH, Matthew B. Dellinger, BS, Bruce H. Gray, DO, Eugene M. Langan, III, MD, Christopher G. Carsten, III, MD.
Greenville Hospital System, Greenville, SC, USA.
BACKGROUND: Despite low reported patency rates, endovascular therapy may result in symptom relief, limb salvage, maintenance of ambulation and independent living, and overall improved quality of life. The goal of this study was to prospectively assess quality of life and functional outcomes after angioplasty and stenting in patients with chronic leg ischemia.
METHODS: From August to December 2002, 84 patients presenting with 118 chronically ischemic limbs underwent percutaneous transluminal angioplasty (PTA) with/without stenting as part of an ongoing prospective project performed to examine evidence based management of symptomatic peripheral arterial disease (PAD). All patients completed a pre-operative health questionnaire (SF-36) to provide adequate baseline data. Each patient was followed every three months after treatment for a period of one year to determine traditional outcomes of arterial patency, limb salvage, survival and amputation-free survival and functional outcomes assessed according to improvement in quality of life, maintenance of ambulatory status and maintenance of independent living status. The entire cohort was analyzed, as were subgroups of patients with lifestyle limiting claudication and those with critical limb ischemia (CLI). Outcomes were analyzed using Kaplan Meier life table analysis, the log rank test for survival curves and the one sample t test.
RESULTS: Of the 84 patients, 54 (64.3%) were treated for claudication and 30 (35.7%) were treated for critical limb ischemia. Results for the eighty-four patients treated included one year primary patency of 64.7%; limb salvage, 93.4%; amputation-free survival, 79.7%; survival, 83.3%; maintenance of ambulation status, 92.3%; and maintenance of independence, 96.1%. SF-36 results showed statistically significant improvement at one year in reference to baseline data in all physical function categories including overall physical function (28.9 + 9.3 vs. 35.3 + 12.4, p<0.0001), role-physical (31.9 + 12.0 vs. 37.3 + 13.5, p=0.0009), bodily pain (35.7 + 9.4 vs. 43.9 + 11.3, p<0.0001), and aggregate physical scoring (30.2 + 11.0 vs. 36.5 + 12.2, p<.0.0001). One year results for the 54 patients with claudication were: primary patency, 78.5%; limb salvage, 100%; amputation-free survival, 94.9%; survival, 96.3%; maintenance of ambulation status, 100%; maintenance of independence, 100% and statistical improvement at all physical function categories. One year results for the 30 patients with critical limb ischemia were: primary patency, 35.2%; limb salvage, 77.2%; amputation-free survival, 50.0%; survival, 60.0%; maintenance of ambulation status, 75.8%; maintenance of independence, 92.8% and statistical improvement in bodily pain resolution.
CONCLUSIONS: Recent technological advancements have enabled vascular specialists to treat increasingly complex PAD using percutaneous techniques which result in acceptable technical results, as well as improved functional outcomes and overall greater patient satisfaction.
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