Prospective 2-Years Follow-up Quality of Life Study after Infrageniculate Bypass Surgery for Limb Salvage: Lasting Improvements Only in Non-diabetic Patients

Abstract

Improvement in HRQoL is sustained for more than 12 months after successful infrageniculate bypass surgery. Therefore, an aggressive approach towards revascularisation seems to be justified from the patient's perspective. However, this benefit in quality of life is less in diabetic patients, despite similar limb-salvage rates.

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

“…The population norms in the United States for each of the SF-36 domains are as follows: physical functioning, 50.7; role physical, 49.5; bodily pain, 50.6; general health, 50.1; vitality, 53.7; social functioning, 51.4; role emotional, 51.4; mental health, 54.3; physical component summary, 49.2; and mental component summary, 53.8 49Table 6Baseline SF-36/RAND-36 quality of life scores (0–100) for patients with CLIPublicationInstrumentPFRPBPGHVTSFREMHPCSMCSCLI PopulationProcedure(s)Burt (2010)38SF-36––––––––31.157.6100%Autologous peripheral blood cell implantationDeutschmann (2007)39SF-3624.85.613.950 a 28.170 a 28.546 a ––52%Percutaneous transluminal angioplastyEngelhardt b (2008)40SF-362512215641503856100%Infrageniculate bypass surgeryForbes (2010)41SF-36SF-3622.723.010.313.130.432.049.148.034.236.340.644.231.536.358.960.1100% c 100% c AngioplastyBypass sur...…”

“… Notes: a Baseline SF-36 scores estimated from figure #3 in Deutschmann 2007;39 bA weighted average of the baseline SF-36 scores for the three patient subgroups (Non-Diabetes, Diabetes, and Secondary Amputation) from Table #3 in Engelhardt 2008;40 cCLI population defined as “severe lower limb ischemia” in the Forbes 201041 study (BASIL trial); d For the purpose of this analysis, the CLI patient population from the Peeters Weem 201645 study was defined as patients with “no option severe limb ischemia”; baseline SF-36 scores estimated from figure #2 in Peeters Weem 2016;45 eFor the purposes of this analysis, the SF-36 scores presented in the table earlier are from Table II in the van Hattum 201147 study for the Bypass and Oral Anticoagulants or Aspirin (BOA) Study group. Abbreviations: BP, Bodily Pain; CLI, critical limb ischemia; GH, General Health; MCS, Mental Component Summary; MH, Mental Health; PCS, Physical Component Summary; PF, Physical Functioning; RAND-36, 36-item Short-Form Health Survey; RE, Role Emotional; RP, Role Physical; SF, Social Functioning; SF-36, 36-item Short-Form Health Survey; VT, Vitality.…”

Critical Limb Ischaemia: Initial Treatment and Predictors of Amputation-free Survival

“…4,16,32 Furthermore, an attempt seems justified if technically feasible, as diabetics very well benefit from bypass surgery in terms of quality of life, albeit to a lesser extent than non-diabetic patients. 30,31 In only few patients final functional outcome could be assessed, as survival of patients with CLI generally is poor, especially in cohorts with a high incidence of diabetes and renal insufficiency, as in this series. Half of the surviving patients had received some form of revascularisation, and nearly all revascularised patients with viable limbs were able to walk at least 1 km independently without any help.…”

Health-related quality of life and prosthesis use among patients amputated due to peripheral arterial disease – a one-year follow-up

“…The mortality is 16-35% in the first year after being diagnosed with critical limb ischemia, and it seems to continue at the same level [4,5]. PAD is a disease with a large impact on the patient's Health-Related Quality of Life (HRQoL) as it is associated with a high risk of lower extremity amputation, morbidity, and death [6][7][8]. It is a disease associated with a lower HRQoL in comparison with the general population, and revascularization may improve the patient's perceived health status [9][10].…”