Objectives: Outcome measures of revascularization for critical limbischemia (CLI) have historically been patency, survival, and amputation.Functional status and quality of life (QOL) assessments have not been welldescribed. This study used functional assessments and QOL questionnairesto measure patient-centered outcomes after revascularization for CLI.Methods: Eighteen patients (mean age, 65 ± 11 years) were monitoredprospectively before and after lower extremity bypass for CLI. Musclestrength was assessed preoperatively and postoperatively with tests of kneeand flexion, ankle dorsiflexion, ankle plantar flexion, elbow and extension,and handgrip for ipsilateral and contralateral limbs using the Muscle FunctionEvaluation chair (MFEC). Patients completed the Short Physical PerformanceBattery (SPPB), which measures walking speed, leg strength, andbalance, a 6-minute walk, and caloric expenditure with an accelerometer.QOL instruments included the Short Form 36 (SF-36), Vascular Quality ofLife (VascuQol).Results: Ankle-brachial indices (ABI) in the ipsilateral leg increased0.46 ± 0.17 (mean ± SD) to 0.88 ± 0.21 (P < .001). Mean follow-up was121 ± 57 days. MFEC measurements of ipsilateral leg strength demonstratedknee flexion increase from 64±63 to 135±133N(P=.038). Kneeextension increased from 120 ± 110 to 186 ± 85 N, which approachedsignificance (P= .062), as did ankle plantar flexion, which increased from178±126 to 267±252 N (P=.078). In the contralateral leg, knee flexionincreased from 71 ± 96 to 149 ± 162 N (P = .028), and knee extensionincreased from 162 ± 112 to 239 ± 158 N (P = .036). Nearly all upperextremity strength measurements showed an absolute decrease postoperatively,but this change was not significant. Absolute improvements werenoted in 6-minute walk distance, daily caloric expenditure, and in individualdomains and overall SPPB scores, although none were significant. TheVascuQol captured the most significant QOL improvement in individualdomains, and overall score (P=.015 for each domain). Significant improvementwas noted only for Body Pain (P=.011) using the SF-36.Conclusions: Revascularization for CLI results in improved musclestrength, leg function, and patient-perceived function using a diseasespecificquestionnaire (VascuQol). Decline in upper extremity strength andunimproved SF-36 domain scores suggest an overall deconditioning afterrevascularization despite leg improvements.
Landry, G., Esmonde, N., Liem, T., Mitchell, E., & Moneta, G. (2011). Functional Outcomes of Revascularization for Critical Limb Ischemia. Journal of Vascular Surgery, 53(2), 556. https://doi.org/10.1016/j.jvs.2010.11.080