2007, Number 3
Lower-limb critical ischemia. Impact of treatment in quality of ife
Rosas FMÁ, Zarraga RJL, Serrano LJA, Huerta HH, Soriano AG, Antúnez GF, Jordán LJC, Cisneros TM, Sánchez NN
Full text
Language: Spanish
References: 16
Page: 95-101
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ABSTRACT
Background: For the past decades morbidity and mortality rates from lower-limb critical ischemia have been constantly high. This can be explained partially because of the co-morbidities associated with the disease (myocardial infarction, stroke, diabetes mellitus, chronic renal failure, hypertension, etc). Since 1990 long-term quality of life as a parameter of successful treatment for critical lower-limb ischemia has get particular attention in the medical literature. Positive impact from surgical treatment (revascularization) has been reported in many American and European papers. There is a lack of such studies in Mexico. It was the author´s purpose to provide an insight in this topic.Objectives: To determine the impact of quality of life from surgical treatment (revascularization) in patients with lower-limb critical ischemia.
Methods: This is a prospective, longitudinal, comparative and open study. Since March 2004 to August 2006 patients diagnosed with critical lower-limb ischemia treated in our service were included. Short form 36 health questionnaire was applied to all patients before treatment at the time of hospital admission and 6 months after the surgical procedure was done to evaluate quality of life. Short form 36 health questionnaire is the most widely used instrument to evaluate health status. It explores 8 specific topics of health status: physical performance, social performance, function limitations, organic and emotional issues, mental health, vigor, pain and health status self-perception. Scale punctuation goes from 0 to 100, been the highest score related with a better quality of life. Descriptive and inferential statistic analysis were performed to evaluate the results.
Results: 45 patients were included in the study. There were 24 females and 21 males. Age range was from 55 to 88 years (mean age 69.8 years). 37 patients presented with lower limb necrosis and 7 patient presented with pain at rest. The following surgical procedures were done: 2 femoral-femoral bypasses; 23 femoral-poplyteal bypasses, 3 aortobifemoral bypasses; 3 poplyteal bypasses and 4 extraanatomic bypasses. At 6-month follow up 37 patients remained major amputation-free and 8 patients had lost their extremities. Short form 37 questionnaire results were: Physical problems: Admission mean 34.24, DS 9.43, 6-month mean 64.42, DS 10.20; function limitations: Admission mean 36.48, DS 11.41 6-month mean 69.35, DS 10.22; pain: Admission mean 36.96, DS 6.78; 6-month mean 72.31, DS 9.85; health status self-perception: Admission mean 35.68, DS 12.19; 6-month mean 73.15, DS 10.84; vigor Admission mean 52.44, DS 11.99; 6-month mean 75.66, DS 8.65; social performance: Admission mean 53.88, DS 11.06; 6-month mean 76.91, DS 9.80; emotional issues: Admission mean 52.77, DS 12.08 6-month mean 78.68, DS 9.20; mental health: Admission mean 53.31, DS 11.78; 6-month mean 79.44, DS 6.75; total mental health score: Admission mean 53.10, DS 9.21; 6-month mean 77.68, DS 7.01; total physical health score: Admission mean 35.84, DS 7.33; 6-month mean 69.83, DS 9.00. Inferential statistic analysis (couple variables t-Student). When comparing the short form 36 questionnaire score results, improvement in quality of life after surgical treatment was demonstrated (mean 6-month follow up; p ‹ 005, IC 95%).
Conclusions: Lower-limb critical ischemia decreases quality of life. Because of this, it is important to provide an expeditious and an effective treatment for this entity. Surgical revascularization provides an important improvement in physical and mental health which translates in a better quality of life. It is important to assess quality of life as a parameter of successful treatment in lower-limb critical ischemia and in others diseases in which the vascular surgeon gets involved.
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