EFFECT OF LOWER-EXTREMITY BLOOD-PRESSURE ON PHYSICAL FUNCTIONING IN PATIENTS WHO HAVE INTERMITTENT CLAUDICATION

Purpose: Claudication patients' perceptions of walking impairment ofte n influence recommendations for peripheral bypass and angioplasty. The actual relationship between lower extremity blood flow and physical f unctioning, however, has rarely been explicitly studied. Methods: Pati ents were enrolled at a visit to one of 16 vascular surgery offices an d clinics that participated in a prospective outcomes study. A total o f 555 patients (445 men and 110 women) with an abnormal ankle-brachial index (ABI), none of whom had had previous leg revascularization or s ymptoms of rest pain, skin ulcers, or gangrene, completed the SF36 Hea lth Survey and the Peripheral Arterial Disease Walking Impairment Ques tionnaire (WIQ). Stepwise multiple regression analysis was used to tes t the statistical significance and strength of association between pat ients' ABI level and SF36 physical functioning (PP) and WIQ community walking distance scores, controlled for sociodemographic characteristi cs and the presence and severity of comorbid conditions. Results: Univ ariate correlations with ABI were modest but significant (PF score, r = 0.12, p = 0.004; WIQ distance score, r = 0.18, p < 0.001). ABI was a very significant predictor of both PF (b = 18.8; p = 0.001) and WIQ s cores (b = 0.33; p < 0.0001) in the multiple regression analysis. Othe r positive predictors of PF scores were high-school graduation and mal e sex. Negative predictors of PP scores were heart, lung, and cerebrov ascular disease; knee arthritis and chronic back pain; and enrollment at a Veterans Administration clinic rather than a private community or academic office. Conclusion: Cross-sectional findings indicate that a 0.3 improvement in ABI is associated with an average improvement of 5 .6% in PF or 10.3% in WIQ distance score. However, proper selection of individual candidates for interventional therapy, that is, those pati ents who have lower ABIs, lower initial functioning, and fewer disabli ng comorbidities would be predicted to produce a much greater function al benefit. Surgeons should make a rigorous functional evaluation when recommending interventional management of claudication.