Percutaneous transluminal angioplasty for intermittent claudication: Evidence on which to base the medicine

Objectives: this study aims to assess the impact of PTA on the quality of l ife (QoL) of claudicants and to analyse which patients and which arterial l esions derive the most benefit. Design: a prospective observational study. Materials: one hundred and seventeen claudicants undergoing PTA were studie d; 35 patients had bilateral disease, whilst 82 had unilateral disease and underwent PTA to a solitary iliac lesion, solitary superficial femoral or a iliac lesion above a diseased superficial femoral artery in 24, 39 and 19 cases, respectively. Methods: patients completed the Short Form 36 (SF36) and EuroQol (EQ) Rot a ssessment instruments prior to and at 1, 3, 6, and 12 months following inte rvention. The SF36 produces a QoL profile, whilst the EQ produces two QoL i ndices. Results: claudication has a deleterious effect on QoL, especially in patien ts with multi-segment disease. PTA results in an immediate and lasting impr ovement in the QoL of claudicants. Unilateral claudicants undergoing PTA to a solitary iliac lesion demonstrate the most marked QoL benefits and 12 mo nths post PTA report a QoL approaching that of an age-matched population. P atients with bilateral claudication undergoing unilateral PTA and unilatera l claudicants undergoing PTA to a solitary SFA lesion demonstrate some QoL benefits, but at 12 months post PTA do not approach the QoL scores of an ag e-matched population. Unilateral claudicants undergoing iliac PTA above a d iseased SFA demonstrate minimal Rot changes. Conclusions: these results should influence decision making in the manageme nt of claudication and it may be possible to prioritise PTA waiting lists t o ensure patients with greatest potential benefit are treated with most urg ency.