ABILITY TO WORK AFTER ARTERIAL-SURGERY FOR CHRONIC INCAPACITATING ISCHEMIA OF THE LOWER-LIMB IN MIDDLE-AGED PATIENTS

Objective: To assess the efficacy of arterial surgery in restoring abi lity to walk and working capacity. Design: Retrospective follow up stu dy. Setting: Fourth Department of Surgery, Helsinki University Central Hospital. Subjects: 67 middle-aged patients (mean age 53 years) with chronic incapacitating ischaemia of the lower limb. Interventions: Art erial reconstruction. Main outcome measures: Clinical outcome, vascula r laboratory assessments, mortality, morbidity, return to work, and re tirement. Results: According to objective vascular laboratory criteria a primary positive effect was achieved in 63/67 (94%). Fourty-eight o f the 65 surviving patients (74%) were free of symptoms on treadmill t esting three months after the operation. Working capacity was restored in 41/50 of the patients not yet retired (82%). Three years postopera tively 77% of the surviving patients still fared objectively better th an before operation. The 10-year survival rate was 67%. Fourteen of th e 22 patients who died did so of cardiovascular diseases (64%). Advanc ed distal ischaemia (indicated by a preoperative ankle-brachial index of 0.5 or less) was associated with increased risk of death. Altogethe r 251 working years were achieved of the 435 that could have potential ly been gained. The most common reason for retirement during follow up was progression of peripheral arterial disease in the lower limbs in 13/41 patients (32%). At the end of the study there were nine patients still working with potentially 73 working years left. Conclusion: The se results indicate that arterial surgery can restore working capacity in middle aged patients with threatening or temporary invalidity. Lon g term outcome, especially mortality, is mostly affected by other sign s of cardiovascular disease, whereas working capacity is dependent on a wider variety of factors.