FUNCTIONAL OUTCOME AFTER SURGICAL-TREATMENT FOR INTERMITTENT CLAUDICATION

Purpose: Although patency data for lower extremity bypass grafts are r eadily available, few reports have focused on patients' satisfaction a fter surgical reconstruction for claudication. We reviewed our experie nce with surgical treatment for claudication, focusing on late outcome from the patients' perspective to further refine surgical decision ma king in patients with intermittent claudication. Patients and Methods: From February 1987 through April 1994, 114 consecutive patients under went surgical bypass for intermittent claudication. Nine patients were lost to follow-up, leaving the study cohort composed of 105 patients with a mean age of 63 years (range 42 to 82 years). Sixty-two percent of the procedures were inflow reconstructions, and the remainder were infrainguinal bypasses. Clinical and demographic data were gathered fr om record review, and late follow-up was obtained by return visit or t elephone interview. Patient satisfaction and level of function were as sessed by a simple five-point questionnaire administered by a research nurse. Actuarial methods were used to calculate late graft patency an d survival. Cox regression analysis was used to identify clinical and anatomic factors predictive of late survival and favorable outcome.Res ults: Cardiac risk assessment revealed that 75% of patients either had no clinical markers for cardiac disease or had been treated with. pre vious coronary artery bypass grafting or percutaneous transluminal ang ioplasty; despite this 61% of patients underwent specific preoperative cardiac testing. Most (68%) inflow procedures were aortobifemoral byp ass grafts, and 93% of outflow procedures were femoropopliteal bypass grafts. Two thirds of infrainguinal grafts were performed with autogen ous conduits, with prosthetic femoropopliteal bypass grafts performed only to the above-knee popliteal artery Early graft failure with succe ssful immediate revision occurred in 5% of patients. No operative deat hs or early or late amputations occurred. At a mean follow-up of 4.5 y ears 96% of surviving patients had a patent graft. However, primary un assisted patency at 4 years was superior for inflow (92% +/- 4%) versu s outflow (81% +/- 6%) procedures (p = 0.009). Late readmission for ca rdiac-related events occurred in 12%, and late cardiac-related death o ccurred in 5%. Actuarial. survival at 5 years was 80% +/- 5%, with dia betes being the only negative survival predictor (risk ratio 2.6, 95% confidence interval 1 to 7, p = 0.049); 60% of late deaths were cancer -related. Satisfactory late results were reported by 82% of patients, with age less than or equal to 70 years (odds ratio 4.01, 95% confiden ce interval 1.2 to 13.7, p = 0.026) and normalization (greater than or equal to 0.85) of ankle/brachial index (odds ratio 5.7, 95% confidenc e interval 1.6 to 20, p = 0.008) being powerful independent predictors of patient satisfaction.Conclusions: After considering cardiac-relate d short- and long-term prognosis, we conclude that lower extremity byp ass grafting for intermittent claudication will produce optimal result s when restricted to younger (<70 years) nondiabetic patients in whom near normalization of the postoperative ankle/brachial index can be an ticipated.