Functional outcomes far patients with intermittent claudication: Bypass surgery versus angioplasty versus noninvasive management

D. R. Reifler*, Joseph M Feinglass, R. Slavensky, Gary J Martin, L. Manheim, W. J. McCarthy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Self-reported physical function has only recently been recognized as an important and reliable measure of treatment outcome for patients with peripheral vascular disease. The present study assesses the impact of bypass surgery, angioplasty, and noninvasive management on self-reported physical functioning of patients with intermittent claudication. A retrospective cohort study was conducted of 368 consecutive patients who visited four vascular surgery clinics between 1988 and 1992 with intermittent claudication. In 1993, patients were mailed the SF-36 Health Survey, the Peripheral Artery Disease (PAD) Walking Impairment Questionnaire, and survey questions about comorbidities, demographic characteristics, and satisfaction with treatment. Multiple regression analysis was used to compare physical functioning differences between noninvasively managed patients and patients who underwent subsequent peripheral bypass and angioplasty procedures. The extent to which functional outcomes could plausibly be attributed to treatment was also examined. Of 346 patients not identified as deceased, 187 (54%) responded. Eighty (43%) of the survey respondents had undergone invasive procedures after their initial office visit - 39 angioplasty, 28 bypass, and 13 both treatments. Noninvasively managed patients were older, more often female, and had aortoiliac disease less often but were no different from invasively managed patients in other baseline features including mean ankle-brachial index. The self-reported followup functional status of invasively managed patients was better than that of noninvasively managed patients as measured by the mean SF-36 score for physical functioning (bypass, p < .01; angioplasty p < .05), the PAD Walking Impairment score for distance (bypass, p < .001; angioplasty, p < .01), and self-reported leg symptom improvement (bypass, 78.0% of patients; angioplasty, 74.3%; vs. noninvasive, 25%; p < .0001). Multiple regression analysis identified bypass surgery (p = .03), but not angioplasty, as a significant predictor of physical functioning and community walking distance, after controlling for the simultaneous effects of age, sex, education, marital status, smoking status, initial ankle-brachial index, arterial level of disease, duration of symptoms, followup time, and walking impairment related to comorbidities. Significant correlations between pretreatment ankle-brachial index and follow-up physical functioning were found for the noninvasively managed group, but not for the bypass patients. Bypass surgery was associated with significantly higher self-reported functional status in this group of patients with intermittent claudication. These results appear related to improved lower extremity blood flow for bypass patients, rather than being solely an artifact of placebo effects or surgical selection biases. A higher survey response rate among patients who underwent invasive treatment did not appear to bias the results.

Original languageEnglish (US)
Pages (from-to)203-211
Number of pages9
JournalJournal of Vascular Medicine and Biology
Volume5
Issue number5-6
StatePublished - Dec 1 1994

Keywords

  • Functional assessment
  • Intermittent claudication
  • Percutaneous transluminal angioplasty
  • Peripheral artery bypass surgery
  • Peripheral vascular disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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