Walking ability and quality of life as outcome measures in a comparison of arterial reconstruction and leg amputation for the treatment of vascular disease

Objectives: To compare the walking ability and the quality of life of patients with severe limb ischaemia treated with an arterial reconstruction (AR) or a primary below-knee amputation (BKA). Design: A cohort study of patients with the first episode of ischaemia. Setting: University tertiary referral centre. Patients: Thirty-eight (AR 22, BKA 16) patients were studied over a 12-month period with a complete follow-up. Chief outcome measures: Walking ability was assessed with a subjective scale and quality of life was measured with the Spitzer QL-INDEX. The results were assessed for patients still alive (Step 1) as well as for all patients (Step 2). Results: Walking ability was better in the AX group at 3 (OX = 10.37; CI 2.12, 50.74; p = 0.004), 6 (OR = 6.47; CI 1.83, 22.79; p = 0.004), and 12 (OX = 3.82; CI 1.20, 12.15; p = 0.03) months. Quality of life was significantly better for AR patients at 3 (OR = 4.32; CI 1.55, 12.02; p = 0.005) and 6 (OR = 4.40; CI 1.68, 11.53; p = 0.003) months, but not at 12 months (OX = 2.44; CI 0.95, 6.26; p = 0.06). The 12 month foot salvage rate was 68%. Conclusion: Walking ability and quality of life are better for AX patients than for BKA patients, even with a moderate foot salvage rate.