Background
Revascularization is the cornerstone in the treatment of patients with critical limb-threatening
ischemia (CLTI). However, the 2-year mortality rate is up to 50% in these patients.
Therefore, the clinical benefit of revascularization needs to be considered carefully.
The question emerges if there are changes in quality of life (QoL) and health status
(HS) in the end-of-life phase of CLTI in older patients.
Methods
Patients with CLTI and of an age of 70 years or older were included in a prospective
observational cohort study. Treatment consisted of endovascular revascularization,
surgical revascularization, or conservative therapy. The follow-up period was 2 years.
Within this follow-up period, patients completed the following questionnaires at six
specified time intervals: the WHOQOL-BREF and the SF-12. Patients who died within
2 years after inclusion were analyzed. Final scores were defined as the last measurement
at end of follow-up or death.
Results
Eighty two patients (42.1%) died during the 24-month follow-up. QoL and HS before
death did not decrease with treatment (option: endovascular intervention, surgical
revascularization, or conservative therapy).
Conclusions
Older patients with CLTI and a life expectancy less than 2 years had no differences
in QoL and HS before death compared to their previous measurement. Except for the
mental HS domain, no differences in the percentage of patients showing significant
individual change in QoL and HS were found between the treatments. For clinicians,
it is important to use patient-reported outcome measure when discussing treatment
for older frail patients with CLTI in a shared decision-making process.
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References
- Global vascular guidelines on the management of chronic limb-threatening ischemia.Eur J Vasc Endovasc Surg [Internet]. 2019; 58: S1-S109
- The current state of critical limb ischemia a systematic review.JAMA Surg. 2016; 151: 1070-1077
- Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial.Lancet. 2005; 366: 1925-1934
- Inter-society consensus for the management of peripheral arterial disease (TASC II).J Vasc Surg. 2007; 45: 5-67
- Conservative treatment in selected patients with severe critical limb ischemia.World J Surg [Internet]. 2015; 39: 2090-2095
- Quality of life and mortality after endovascular, surgical or conservative treatment of elderly suffering from critical limb ischemia.Ann Vasc Surg. 2018; 51: 95-105
- Clinically meaningful change: false positives in the estimation of individual change.Psychol Assess. 2014; 26: 370-383
- Two-year life expectancy in patients with critical limb ischemia.JACC Cardiovasc Interv [Internet]. 2014; 7: 1444-1449
- Not all patients with critical limb ischaemia require revascularisation.Eur J Vasc Endovasc Surg [Internet]. 2017; 53: 371-379
- One-year results of first-line treatment strategies in patients with critical limb ischemia (CRITISCH Registry).J Endovasc Ther [Internet]. 2018; 25: 320-329
Article info
Publication history
Published online: October 19, 2019
Accepted:
October 1,
2019
Received:
August 1,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
