Objective measurement of lower extremity function and quality of life after surgical revascularization for critical lower extremity ischemia

Landry, Gregory J.; Esmonde, Nick O.; Lewis, Jason R.; Azarbal, Amir F.; Liem, Timothy K.; Mitchell, Erica L.; Moneta, Gregory L.

doi:10.1016/j.jvs.2014.01.067

Cited by 21 publications

(18 citation statements)

References 31 publications

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“…3). In the available literature there are no analyses that are similar to the analysis carried out in this study, apart from the work of Landry et al [16]. However, the results obtained indirectly corroborate with the reports of other authors who indicated to the prognostic significance of patients' nutritional status, determined mainly by the BMI value, as regards the effect of revascularization of the limbs and the occurrence of possible complications [10,[16][17][18][19][20][21].…”

Section: Discussionsupporting

confidence: 88%

“…In the available literature there are no analyses that are similar to the analysis carried out in this study, apart from the work of Landry et al [16]. However, the results obtained indirectly corroborate with the reports of other authors who indicated to the prognostic significance of patients' nutritional status, determined mainly by the BMI value, as regards the effect of revascularization of the limbs and the occurrence of possible complications [10,[16][17][18][19][20][21]. It is also known that patients with chronic lower limb ischemia are characterized by impaired fitness [22][23][24][25][26][27][28], and supervised walking training and physical activity help reduce the severity of the chronic limb ischemia symptoms [29][30][31][32], which allows explaining the demonstrated better prognosis regarding the outcome of revascularization treatment in stronger and more fit patients, like those who have a better chance of earlier returning to full physical activity after the surgery.…”

Section: Discussionmentioning

confidence: 98%

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The association between nutritional and functional status in patients undergoing endovascular intervention due to chronic lower limbs ischemia

Siódmiak

Falkowski

et al. 2018

Medical Research Journal

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Background: The nutritional status and functional status of patients are important prognostic factors. The aim of the study was to assess the relationships between patients' nutritional status and the outcome of endovascular intervention in patients with chronic lower limb ischemia during one-year follow-up. Materials and methods: In 79 consecutive patients subjected to endovascular intervention due to chronic leg ischemia following examinations were performed before and after 3 and 12 month after surgery: physical examination, Minimal Nutritional Assessment (MNA) score, Nutritional Risk Screening 2002 score (NRS2002), Barthel, ADL, IADL scale, ankle-brachial index (ABI), claudication distance on the treadmill and handgrip strength. Results: More than half of patients were initially overweight or obese. Following 3 months after the surgery, improvement in lower limb symptoms was observed, together with significant increase in ABI, claudication distance, total MNA score and IADL scale. The risk associated with malnutrition (MNA questionnaire), Barthel score and hand grip strength showed a statistically significant relationship with the subjective feeling of improvement after surgery. Its absence was more frequent in patients characterized by higher risk of malnutrition, with less muscular strength and poorer fitness. Conclusions: Endovascular treatment of lower limbs ischemia improved not only symptoms of leg ischemia but also the general functional status of patients. The initial nutritional status, functional status and hand grip strength of patients with chronic lower limb ischemia were associated with a better clinical outcome of endovascular intervention.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 98%

The association between nutritional and functional status in patients undergoing endovascular intervention due to chronic lower limbs ischemia

Siódmiak

Falkowski

et al. 2018

Medical Research Journal

View full text Add to dashboard Cite

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“…For example, Forbes and colleagues (2010) evaluated quality of life using the VascuQOL-25 (scoring from 1 to 7) in 452 CLI patients enrolled in the BASIL trial and found low pre-operative baseline scores in both the angioplasty group (2.8) and bypass surgery group (2.9) 41. Similarly, Landry and colleagues (2014) evaluated quality of life in 18 CLI patients undergoing lower extremity bypass surgery and found a low VascuQOL-25 score of 2.9 at baseline indicating a substantial quality of life burden in these patients 44…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have reported baseline VascuQOL in CLI patients from clinical trials of various revascularization procedures and medical therapies 37,41,44,56–60. In all of these CLI intervention studies, low baseline VascuQOL scores were consistently observed indicating that patients have an impaired quality of life at baseline prior to undergoing an intervention.…”

Section: Resultsmentioning

confidence: 99%

<p>The burden of critical limb ischemia: a review of recent literature</p>

Duff

Mafilios²,

Bhounsule

et al. 2019

VHRM

243

154

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Peripheral arterial disease is a chronic vascular disease characterized by impaired circulation to the lower extremities. Its most severe stage, known as critical limb ischemia (CLI), puts patients at an increased risk of cardiovascular events, amputation, and death. The objective of this literature review is to describe the burden of disease across a comprehensive set of domains—epidemiologic, clinical, humanistic, and economic—focusing on key studies published in the last decade. CLI prevalence in the United States is estimated to be approximately 2 million and is likely to rise in the coming years given trends in important risk factors such as age, diabetes, and smoking. Hospitalization for CLI patients is common and up to 60% are readmitted within 6 months. Amputation rates are unacceptably high with a disproportionate risk for certain demographic and socioeconomic groups. In addition to limb loss, CLI patients also have reduced life expectancy with mortality typically exceeding 50% by 5 years. Given the poor clinical prognosis, it is unsurprising that the quality of life burden associated with CLI is significant. Studies assessing quality of life in CLI patients have used a variety of generic and disease-specific measures and all document a substantial impact of the disease on the patient’s physical, social, and emotional health status compared to population norms. Finally, the poor clinical outcomes and increased medical resource use lead to a considerable economic burden for national health care systems. However, published cost studies are not comprehensive and, therefore, likely underestimate the true economic impact of CLI. Our summary documents a sobering assessment of CLI burden—a poor clinical prognosis translating into diminished quality of life and high costs for millions of patients. Continued prevention efforts and improved treatment strategies are the key to ameliorating the substantial morbidity and mortality associated with this disease.

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“…Indeed, in a prospective study following 18 patients with CLI, surgical revascularization improved muscle strength, 6-min walk distance, bodily pain and overall quality of life. 60 However, these muscular parameters are not currently tested in routine clinical practice, and therefore, we do not know whether ischemia-related muscle impairment are normalized or whether sequela remain. Nevertheless, additional therapeutic approaches like exercise training or angiogenesis therapies seems useful to further sustain 63 These results might indicate that exercise intensity could be associated with adverse effects on skeletal muscle function and might also underscore the beneficial systemic effects of exercise.…”

Section: Treating Sarcopenia In Padmentioning

confidence: 99%

Sarcopenia and peripheral arterial disease: a systematic review

Pizzimenti

Meyer

Charles

et al. 2020

J cachexia sarcopenia muscle

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Background Patients with lower extremity peripheral arterial disease (PAD) and sarcopenia are a population at risk requiring specific and targeted care. The aim of this review is to gather all relevant studies associating sarcopenia and PAD and to identify the underlying pathophysiological mechanisms as well as potential therapeutic strategies to improve skeletal muscle function. Methods A systematic review was carried out following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results Data extraction allowed the evaluation of 140 publications; 87 met the inclusion criteria; of which 79 were included in the final review, reporting sufficient data for epidemiological and diagnostic criteria, mechanical analysis, and therapeutic approaches. Epidemiological analysis and diagnostic criteria were based on 18 studies following 2362 PAD patients [31.39% (SD 7.61) women], aged 72.42 (SD 2.84); sarcopenia was present in 34.63% (SD 12.86) of the patients. Mechanical and pathway analysis were based on five animal studies and 29 clinical reports, showing significantly altered muscle strength and function in 1352 PAD patients [26.49% (SD 17.32) women], aged 67.67 (SD 5.14) years; impaired muscle histology in 192 PAD patients (9.2% (SD 11.22) women), aged 64.3 (SD 0.99) years; +58.63% (SD 25.48) of oxidative stress in 69 PAD patients [16.96% (SD 8.10) women], aged 63.17 (SD 1.43) years; mitochondriopathy in 153 PAD patients [29.39% (SD 28.27) women], aged 63.50 (SD 1.83) years; +15.58% (SD 7.41) of inflammation in 900 PAD patients [40.77% (SD 3.71) women], aged 74.88 (SD 2.76) years; and altered signalling pathways in 51 PAD patients [34.45% (SD 32.23) women], aged 72.25 (SD 5.25) years. Therapeutic approaches analysis was based on seven animal studies and 21 clinical reports. In total, 884 patients followed an exercise therapy, and 18 received an angiogenesis treatment; 30.84% (SD 17.74) were women. Mean ages of patients studied were 66.85 (SD 3.96). Conclusions Sarcopenia and lower extremity PAD have musculoskeletal consequences that directly impair patients' quality of life and prognosis. Although PAD is primarily a vascular disease, all etiological factors of sarcopenia identified so far are present in PAD. Indeed, both sarcopenia and PAD are accompanied by oxidative stress, skeletal muscle mitochondrial impairments, inflammation, inhibition of specific pathways regulating muscle synthesis or protection (i.e. IGF-1, RISK, and SAFE), and activation of molecules associated with muscle degradation. To date, besides revascularization, the best therapeutic strategy includes exercise, but approaches targeting the underlying mechanisms still deserve further studies.

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Objective measurement of lower extremity function and quality of life after surgical revascularization for critical lower extremity ischemia

Cited by 21 publications

References 31 publications

The association between nutritional and functional status in patients undergoing endovascular intervention due to chronic lower limbs ischemia

The association between nutritional and functional status in patients undergoing endovascular intervention due to chronic lower limbs ischemia

<p>The burden of critical limb ischemia: a review of recent literature</p>

Sarcopenia and peripheral arterial disease: a systematic review

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