A PROSPECTIVE-STUDY OF THE EFFECT OF LIMB-THREATENING ISCHEMIA AND ITS SURGICAL-TREATMENT ON THE QUALITY-OF-LIFE

Objective: To assess the quality of life after treatment for limb-thre atening ischaemia. Design: An open, prospective, observational study i n a Vascular Unit of a University Hospital. Materials: One hundred and fifty consecutive patients presenting with actual or threatened tissu e loss of the leg. Methods: A single, experienced observer assessed th e patients for pain, mobility, anxiety, depression, self-care and life style at presentation, 6 and 12 months later. Results: Six different t reatment outcomes were recognised: successful angioplasty, successful thrombolysis/thrombectomy, successful surgical bypass, amputation afte r failed revascularisation, primary unilateral amputation and primary bilateral amputation. Pain was significantly improved in all groups (p <0.05) except for patients after failed revascularization (p=0.08). Mo bility improved in patients who underwent angioplasty (p=0.05) or a su ccessful surgical bypass (p=0.001). Anxiety and depression both improv ed significantly only after surgical reconstruction (p<0.02). Self-car e ability improved significantly after angioplasty (p<0.05), surgical reconstruction (p<0.005) and unilateral primary amputation (p<0.05), b ut was unaltered in the other groups. Lifestyle significantly deterior ated following thrombolysis/thrombectomy and failed surgical reconstru ction (p<0.05), but was maintained in all other groups. Conclusions: T he treatment of limb-threatening ischaemia should aim to maintain pre- morbid lifestyle, an aim which is best achieved by limb-salvage. The p atient's own expectations and needs have a major bearing on the choice of therapy.