SURGERY FOR LIMB-THREATENING ISCHEMIA - A REAPPRAISAL OF THE COSTS AND BENEFITS

Objectives: To study the quality of life of patients following surgery for critical limb ischaemia. Design: Part retrospective, part prospec tive open study. Setting: Vascular unit of a University Hospital. Mate rials: Seventy-nine consecutive patients, median age 75 years (range 4 4 to 94), who presented with leg threatening ischaemia and who underwe nt successful revascularisation or a major amputation were studied. Ch ief Outcome Measures: Six separate quality of life measures were recor ded at 6 months: pain, mobility, anxiety, depression, activities of da ily living (Barthel) and lifestyle (Frenchay). Main Results: The morta lity of this group of patients after six months was 24%. Forty-seven p atients were available for quality of life assessment six months after initial intervention. Overall, amputation was move costly than succes sful revascularisation and limb salvage. Limb salvage resulted in grea ter mobility (p < 0.001) and better performance in self-care (p < 0.00 1) and lifestyle (p = 0.006), belt produced more anxiety and depressio n (p = 0.04) than major amputation. A subgroup of patients who had maj or amputation after a failed limb salvage operation consumed a disprop ortionate amount of resources and, although their mobility was typical of amputees, their self-care and lifestyle scores were similar to tho se who had successful limb salvage. Conclusions: Limb salvage is attem pted in tip to 22% of patients for whom primary amputation may provide more expeditious rehabilitation with minimal impairment of their life style performance.