Zusammenfassung

BACKGROUND: Outcomes of revascularization for critical limb ischemia (CLI) have historically been patency, limb salvage and survival. Functional status and quality of life (QOL) have not been well described. This study utilized functional and QOL assessments to measure patient-centered outcomes following revascularization for CLI. METHODS: 18 patients (age 65±11 yrs) were followed prospectively before and after lower extremity bypass for CLI. Patients completed the Short Physical Performance Battery (SPPB) which measures walking speed, leg strength and balance, as well as performing a 6 minute walk, and measuring caloric expenditure with an accelerometer. Isometric muscle strength was assessed using the Muscle Function Evaluation chair (MFEC). QOL instruments included the Short Form 36 (SF-36) and Vascular Quality of Life (VascuQol). Patients’ preoperative status was compared with four month postoperative status. RESULTS: MFEC measurements of ipsilateral leg strength demonstrated a significant increase in knee flexion from 64±63 Newtons (N) to 135±133N (p=0.038), and near significant increase in knee extension 120±110N to 186±85N (p=0.062) and ankle plantar flexion 178±126N to 267±252N (p=0.078). In the contralateral leg, knee flexion increased 71±96N to 149±162N (p=0.028), knee extension 162±112N to 239±158N (p=0.036). Absolute improvements were noted in 6 minute walk distance, daily caloric expenditure and in individual domains and overall SPPB scores, and upper extremity strength decreased, though none were significant. The VascuQol captured significant improvement in all individual domains, and overall score (p<0.015). Significant improvement was noted only for Body Pain (p=0.011) using the SF-36. CONCLUSIONS: Despite lack of statistical improvement in most functional tests, revascularization for critical limb ischemia results in improved patient perceived leg function. Significant improvements in isometric muscle strength may explain the measured improvement in quality of life following revascularization ...