Quality of life after infrainguinal bypass grafting surgery

Purpose: The purpose of this study was to compare quality of life in patien ts with and without various ischemic complications after infrainguinal bypa ss grafting surgery for occlusive vascular disease. Methods: A sample of patients (n = 746) randomized in the Dutch BOA study ( n = 2645), a multicenter trial that compared the effectiveness of oral anti coagulant therapy with aspirin in the prevention of infrainguinal bypass gr aft occlusions, was entered in this study. On the basis of clinical outcome s of the trial, the patients were grouped as follows: patients with patent grafts (n = 409); patients with nontreated graft occlusions, subdivided int o an asymptomatic group (n = 32) and a symptomatic group (n = 65); patients with subsequent revascularizations (n = 194); patients with amputations (n = 36); and patients with failed secondary revascularizations followed by s econdary amputation (n = 38). In case an outcome event occurred, the patien ts were regrouped accordingly. Every half year, the patients completed a Sh ort Form-36 and a EuroQol questionnaire. A multilevel model was used for re peated measure analysis. Results: The mean follow-up time was 21 months. The quality of life in pati ents with nontreated asymptomatic occlusions was roughly similar to the qua lity of life in patients with patent grafts. Patients with symptomatic nont reated occlusions had the lowest outcome with regard to pain as compared wi th the other groups. Furthermore, physical and social functioning was lower for these patients than for patients with patent grafts. Revascularization s, successful or not, negatively affected pain, social functioning, and phy sical and emotional role. After successful revascularization, some improvem ent was observed in pain, physical and social functioning, and general and mental health as compared with the group with nontreated symptomatic occlus ions. Amputation deteriorated physical functioning strikingly, especially a fter failed secondary revascularization. These patients also had the lowest scores of all the groups in the dimensions of social functioning, physical and emotional role, and mental health. EuroQol score showed deterioration of quality of life after all events, except for asymptomatic occlusions. Th e same patterns emerged if we stratified our analysis according to the indi cation for the initial operation: claudication or Limb salvage. Quality of life was constant over time in all the groups in the observed period. Conclusion: Quality of life in patients with asymptomatic occluded grafts i s similar to quality of life in patients with patent grafts. Revascularizat ion of symptomatic occluded grafts improves quality of life to a certain ex tent. Amputation, in particular after failed secondary revascularization, s eemed to be the lowest possible outcome. The results of the Short Form-36 a nd EuroQol measurements were in line with the clinical expectations. The as sociation of disease severity with scores on the instruments supports the c onstruct validity of these outcome measures for an objective assessment of quality of life in controlled studies.