Quantifying Improvement in Symptoms, Functioning, and Quality of Life After Peripheral Endovascular Revascularization

Abstract

Background— Patients with peripheral arterial disease often undergo peripheral endovascular revascularization (PER) to alleviate symptoms. Despite the growth of PER, little information exists quantifying the health status benefits after the procedure. Methods and Results— From February 2001 to August 2004, 477 consecutive patients underwent PER for symptomatic peripheral arterial disease. Of these, 300 consented to participate in a longitudinal follow-up study of their health status. Health status was quantified with the disease-specific Peripheral Artery Questionnaire and the generic Short Form-12 and the EuroQol 5 Dimensions (EQ5D)questionnaire. Scores range from 0 to 100; higher scores represent fewer symptoms and better health status. The average age of the cohort was 68±11 years (mean±SD); 186 (62%) were male, 288 (96%) were white, and 118 (39%) were diabetic. Clinical follow-up was attained in 99% of patients; health status assessments were made in 86%. Mean Peripheral Artery Questionnaire summary scores improved significantly after revascularization from 31±19 to 62±27 at 1 year ( P <0.0001). Generic health status scores also improved significantly ( P <0.001 for all). Despite a technically successful procedure in 98% of patients, 21% of patients did not achieve the minimal clinically important improvement of an 8-point change in Peripheral Artery Questionnaire Summary score after PER (35±19 at baseline versus 31±16 at 1 year; P =0.09). Conclusions— For most patients, significant and sustained improvements in symptoms, functioning, and quality of life occur after PER. Identifying and counseling patients less likely to benefit from PER is an important future research direction.

Wire-Interwoven Nitinol Stent Outcome in the Superficial Femoral and Proximal Popliteal Arteries

“…24,25 Evaluation at 12 months demonstrated 13 to 35 point improvement in all Peripheral Artery Questionnaire scales; overall summary score increased 32 points, 4× the threshold considered to be clinically important. 26 …”

Impact of peripheral arterial disease on health status: A comparison with chronic heart failure

“…2,4 In addition to their increased cardiovascular risk, PAD patients are known to experience impaired health status due to lower-limb symptoms, sometimes even after receiving a technically successful endovascular revascularization. 5,6 In an era where patient-centered outcomes are becoming an important standard in evaluating treatment options, 7,8 information about subjective health status and its determinants in PAD is relatively under documented as compared with the body of research on health status that is available in other cardiovascular disease groups. This information will be necessary when designing tailor-made disease management programs for PAD patients, as programs developed in cardiac patients are not readily implementable in PAD patients.…”

Clinical validity of a disease-specific health status questionnaire: The Peripheral Artery Questionnaire

“…10 Previous studies also showed that the PAQ had a good test-retest reliability and sensitivity to change. 10,12 In addition, an important issue for the use of disease-specific measures in clinical practice is that they focus on aspects that are relevant for a specific patient population. Our results of the PAQ instrument clearly show the disease-specific nature of this measure, with the PAQ discriminating well between different clinical indices.…”

“…10 Although its psychometric properties 10,11 and sensitivity to change after revascularization 12 were adequately documented, there is limited insight into the ability to discriminate between asymptomatic and symptomatic disease and its correlation with traditional clinical indices of disease severity. 10,12 This study was designed to further document its validity by contrasting PAQ scores in patients with asymptomatic and symptomatic disease and by comparing PAQ scores with PADrelated indices, such as walking disease and an established cardiac risk algorithm. More specifically, clinical validity was studied both in this disease-specific instrument and the EQ-5D, a standardized generic instrument applicable in a wide range of medical conditions, containing a 5-dimensional descriptive health status system (EQ-5D) and a visual analogue scale (EQ VAS).…”