A prospective study of the effect of limb-threatening ischaemia and its surgical treatment on the quality of life

Objective: To assess the quality of life after treatment for limb-threatening ischaemia. Design: An open, prospective, observational study in a Vascular Unit of a University Hospital. Materials: One hundred and fifty consecutive patients presenting with actual or threatened tissue loss of the leg. Methods: A single, experienced observer assessed the patients for pain, mobility, anxiety, depression, self-care and lifestyle at presentation, 6 and 12 months later. Results: Six different treatment outcomes were recognised: successful angioplasty, successful thrombolysis/thrombectomy, successful surgical bypass, amputation after 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). Mobility improved in patients who underwent angioplasty (p=0.05) or a successful surgical bypass (p=0.001). Anxiety and depression both improved significantly only after surgical reconstruction (p<0.02). Self-care ability improved significantly after angioplasty (p<0.05), surgical reconstruction (p<0.005) and unilateral primary amputation (p<0.05), but was unaltered in the other groups. Lifestyle significantly deteriorated following thrombolysis/thrombectomy and failed surgical reconstruction (p<0.05), but was maintained in all other groups. Conclusions: The treatment of limb-threatening ischaemia should aim to maintain pre-morbid lifestyle, an aim which is best achieved by limb-salvage. The patient's own expectations and needs have a major bearing on the choice of therapy.