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.
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