Quality of Life After Revascularization and Major Amputation for Lower Extremity Arterial Disease

  • M. Deneuville
Reference work entry


Lower extremity arterial disease ( LEAD) is not a curable disease and  revascularization procedures have little or no effect on the overall life expectancy. Hence, treatment should be aimed primarily at alleviating symptoms, controlling risk factors and improving health-related quality of life (HRQOL). LEAD is associated with impaired HRQOL not only in physical domains but also in social function, emotional and mental health. LEAD is commonly associated with many risk factors each being capable to deteriorate HRQOL independently.

In contrast to the well-developed body of publications on surgical outcomes, prospective data on patient-oriented outcomes after revascularization are still lacking with a total volume of publications currently below 40.

The available data provide some evidence that successful revascularization immediately improves the HRQOL in patients suffering from ischemic claudication with a lasting benefit on physical functioning for at least 12 months while a trend toward return to baseline values in mental health, emotional and vitality domains is commonly observed. Surprisingly, patients with unsuccessful revascularization with minimal increase in lower limb blood flow still experience some improvement in pain, emotional reactions and family relationships in the first year. In the most severe form of LEAD (critical limb ischemia), an immediate and lasting benefit on HRQOL is seen after successful revascularization although less pronounced than in claudicants. However, despite long-term limb salvage and optimal graft functioning, patients successfully revascularized remain functionally disabled when compared to age-matched subjects, nevertheless they report similar well-being. After major limb amputation, some improvement in HRQOL can be expected through pain relief and the maintenance of mobility either with prosthetic rehabilitation or wheel chair ambulation.

The measurement of HRQOL is clearly needed at baseline and after vascular operations but its future role in the decision making process is yet to be defined.


Limb Salvage Critical Limb Ischemia Limb Amputation Nottingham Health Profile HRQOL Measurement 

List of Abbreviations:


 ankle brachial index


critical limb ischemia


 endovascular therapy


health-related quality of life


intermittent claudication


lower extremity arterial disease


open vascular surgery


percutaneous transluminal angioplasty


Trans-Atlantic Inter-Society Consensus


venous bypass graft


  1. ACC/AHA 2005 guidelines. (2006). J Am Coll Cardiol. 47: 1239–1312.Google Scholar
  2. Aquarius AE, Denollet J, De Vries J, Hamming JF. (2007). J Vasc Surg. 46: 507–512.PubMedCrossRefGoogle Scholar
  3. Albers M, Fratezi AC, De Luccia N. (1992). J Vasc Surg. 16: 54–59.PubMedCrossRefGoogle Scholar
  4. BASIL trial participants. (2005). Lancet. 366: 1925–1934.Google Scholar
  5. Bosch JL, van der Graaf Y, Hunink MGM. (1999). Circulation. 99: 3155–3160.PubMedGoogle Scholar
  6. Breek JC, Hamming JF, De Vries M, van Berge Henegouwen DP, van Heck GL. (1992). J Vasc Surg. 36: 94–99.CrossRefGoogle Scholar
  7. Brothers TE, Robinson JG, Elliott BM. (2007). J Vasc Surg. 45: 701–708.CrossRefGoogle Scholar
  8. Cherr GS, Wang J, Zimmerman PM, Dosluoglu HH. (2007). J Vasc Surg. 45: 744–750.PubMedCrossRefGoogle Scholar
  9. Chetter IC, Spark JI, Scott JA, Kent PJ, Berridge DC, Kester RC. (1998). Br J Surg. 85: 951–955.PubMedCrossRefGoogle Scholar
  10. Chetter IC, Spark JI, Scott JA, Kester RC. (1999). Ann vac Surg. 13: 90–103.Google Scholar
  11. Chong PF, Garratt AM, Golledge J, Greenhalgh RM, Davies AH. (2002). J Vasc Surg. 36: 764–771.PubMedGoogle Scholar
  12. Currie IC, Wilson YG, Bairs RN, Lamont PM. (1995). Eur J Vasc Endovasc Surg. 10: 356–361.PubMedCrossRefGoogle Scholar
  13. Deneuville M, Perrouillet A. (2006). Ann Vasc Surg. 20: 753–760.PubMedCrossRefGoogle Scholar
  14. Deneuville M, Pierrot JM, N’Guyen R. (2008). Arch Cardiovasc Dis. 101: 23–29.PubMedCrossRefGoogle Scholar
  15. Deutschmann HA, Schoellnast H, Temmel W, Deutschmann M, Schwantzer G, Fritz GA, Brodmann M, Hausegger KA. (2007). AJR. 188: 169–175.PubMedCrossRefGoogle Scholar
  16. De Vries M, Ouwendijk R, Kessels AG, de Haan MW, Flobbe K, Hunink MGM, van Engelshoven JMA, Nelemans JP. (2005). J Vasc Surg. 41: 261–268.PubMedCrossRefGoogle Scholar
  17. Engelhardt M, Bruijnen H, Scharmer C, Jezdinsky N, Wölfle K. (2006). Eur J Vasc Endovasc Surg. 32: 182–187.PubMedCrossRefGoogle Scholar
  18. Feinglass J, McCarthy WJ, Slavensky R, Manheim LM, Martin GJ. (2000). J Vasc Surg. 31: 93–103.PubMedCrossRefGoogle Scholar
  19. Gallagher P, Desmon D. (2007). Prosthet Orthot Int. 31: 167–176.PubMedCrossRefGoogle Scholar
  20. Goshima KR, Mills JL Sr, Hughes JD. (2004). J Vasc Surg. 39: 330–335.PubMedCrossRefGoogle Scholar
  21. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. (1995). N Engl J Med. 332: 556–561.PubMedCrossRefGoogle Scholar
  22. Gibbons GW, Burgess AM, Guadagnoli E, Pomposelli FB, Freeman DV, Campbell DR, Miller A, Marcaccio EJ, Nordberg P, LoGerfo FW. (1995). J Vasc Surg. 21: 35–45.PubMedCrossRefGoogle Scholar
  23. Hallin A, Bergqvist D, Fugl-Meyer K, Holmberg L. (1992). Eur J Vasc Endovasc Surg. 24: 255–263.CrossRefGoogle Scholar
  24. Hernandez-Osma E, Cairols MA, Marti X, Barjau E, Riera S. (2002). Eur J Vasc Endovasc Surg. 23: 91–94.Google Scholar
  25. Holtzman J, Cadwell M, Walvatne C, Kane R. (1999). J Vasc Surg. 29: 395–402.PubMedCrossRefGoogle Scholar
  26. Johnson BF, Singh S, Evans L, Drury R, Datta D, Beard JD. (1997). Eur J Vasc Endovasc Surg. 13: 306–314.PubMedCrossRefGoogle Scholar
  27. Khaira HS, Hanger R, Shearman CP. (1996). Eur J Vasc Endovasc Surg. 11: 65–69.PubMedCrossRefGoogle Scholar
  28. Kalbaugh CA, Taylor SP, Blackhurst DW, Dellinger MB, Trent EA, Youkey JR. (2006). J Vasc Surg. 44: 296–303.PubMedCrossRefGoogle Scholar
  29. Klevsgård R, Risberg BO, Thomsen MB, Hallberg IR. (2001). J Vasc Surg. 33: 114–122.PubMedCrossRefGoogle Scholar
  30. Klevsgård R, Fröberg BL, Risberg BO, Hallberg IR. (2002). J Vasc Surg. 36: 310–317.PubMedCrossRefGoogle Scholar
  31. Mehta T, Venkata Subramaniam A, Chetter I, McCollum P. (2006). Eur J Vasc Endovasc Surg. 31: 46–52.PubMedCrossRefGoogle Scholar
  32. Morgan MBF, Crayford T, Murrin B, Fraser CA. (2001). J Vasc Surg. 33: 679–687.PubMedCrossRefGoogle Scholar
  33. Nehler MR, Coll JR, Hiatt WR, Regensteiner JG, Schnickel GT, Klenke WA, Strecker PK, Anderson MW, Jones DN, Whitchill TA, Moskowitz. (2003). J Vasc Surg. 38: 7–14.PubMedCrossRefGoogle Scholar
  34. Nguyen LL, Moneta GL, Conte MS, Bandyk DF, Clowes AW, Seely BL, for prevent III investigators. (2006). J Vasc Surg.44: 977–84.PubMedCrossRefGoogle Scholar
  35. Nicoloff AD, Taylor LM Jr, McLafferty RB, Moneta GL, Porter JM. (1998). J Vasc Surg. 27: 256–263.PubMedCrossRefGoogle Scholar
  36. Novgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR. (2007). J Vasc Surg. 45Suppl: 5A–65A.CrossRefGoogle Scholar
  37. Nylaende M, Abdelnoor M, Stranden E, Morken B, Sandbaek G, Risum O, Jorgensen JJ, Lindahl AK, Arnesen H, Seljeflot I, Kroese AJ. (2007). Eur J Vasc Endovasc Surg. 33: 3–12.PubMedCrossRefGoogle Scholar
  38. Paaske WP, Laustsen J. (1995). Eur J Vasc Endovasc Surg. 10: 226–230.PubMedCrossRefGoogle Scholar
  39. Peel JP, Donnan PT, Fowkes GR, Ruckley CV. (1993). Eur J Vasc Surg. 7: 448–451.CrossRefGoogle Scholar
  40. Pell JP on the behalf of the Scottish Vascular Audit Group. (1995). Eur J Vasc Endovasc Surg. 9: 469–472.Google Scholar
  41. Rajagopalan S, Dellegrottaglie S, Furniss AL, Gillespie BW, Satayathum S, Lameire N, Saito A, Akiba T, Jadoul M, Ginsberg N, Keen M, Port FK, Mukherjee D, Saran R. (DOPPS) (2006). Circulation.114: 1914–1922.PubMedCrossRefGoogle Scholar
  42. Regensteiner JG, Hargarten ME, Rutherford RB, Hiatt WR. (1993). Angiology. 44: 1–10.PubMedCrossRefGoogle Scholar
  43. Rucker-Whitaker C, Greenland P, Liu K, Chan C, Guralnik JM, Criqui MH, Taylor L, Pearce WH, McGrae McDermott M. (2004). J Am Geriatr Soc. 52: 922–930.PubMedCrossRefGoogle Scholar
  44. Sabeti S, Czerwenka-Wenkstetten A, Dick P, Schlager O, Amighi J, Mlekusch I, Mlekusch W, Loewe C, Cejna M, Lammer J, Minar E, Schillinger M. (2007). J Endovasc Ther. 14: 431–437.PubMedCrossRefGoogle Scholar
  45. Seabrook GR, Cambria RA, Freischlag JA, Towne JB. (1999). Cardiovasc Surg. 7: 279–286.PubMedCrossRefGoogle Scholar
  46. Tangelder MJ, McDonnel J, Van Busschbach JJ, Buskens E, Algra A, Lawson JA, Eikelboom BC. (1999). J Vasc Surg. 29: 913–919.PubMedCrossRefGoogle Scholar
  47. Taylor SM, Kalbaugh CA, Blackhurst DW, Hamontree SE, Cull DL, Messich HS, Robertson RT, Lagan EM 3rd, York JW, Carsten CG 3rd, Snyder BA, Jackson MR, Youkey JR. (2005). J Vasc Surg. 42: 227–235.PubMedCrossRefGoogle Scholar
  48. Taylor SM, Kalbaugh CA, Blackhurst DW, Cass AL, Trent AE, Langan EMIII, Youkey JR. (2006). J Vasc Surg. 44: 747–756.PubMedCrossRefGoogle Scholar
  49. Thorsen H, McKenna S, Tennant A, Holstein P. (1992). Eur J Vasc Endovasc Surg. 23: 495–499.CrossRefGoogle Scholar
  50. Wann-Hansson C, Hallberg IR, Risberg B, Klevsgård R. (2004). Health Qual Life Outcomes. 17: 2–9.Google Scholar
  51. Whyman MR, Fowkes FG, Kerracher EM, Gillespie IN, Lee AJ, Housley E, Ruckley CV. (1996). Eur J Vasc Endovasc Surg. 12: 167–172.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • M. Deneuville
    • 1
  1. 1.Service de Chirurgie Vasculaire et ThoraciqueUniversity Hospital (CHU de Pointe-à-Pitre-Abymes)GuadeloupeFrench West Indies

Personalised recommendations