Functional status and walking ability after lower extremity bypass grafting or angioplasty for intermittent claudication: Results from a prospective outcomes study

Joe Feinglass*, Walter J. McCarthy, Rael Slavensky, Larry M. Manheim, Gary J. Martin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

61 Scopus citations

Abstract

Objective: The purpose of this study was the prospective comparison of functional outcomes after lower extremity bypass grafting surgery, angioplasty, or medical management of intermittent claudication. Methods: The study was designed as a prospective cohort study to compare functional outcomes for patients with interventional management to medical management, including a matched (younger, with more disability) subgroup, followed for a mean of 19 months. Sixteen Chicago-area vascular surgery clinics participated in the study. The subjects were consecutively enrolled patients with an abnormal ankle-brachial blood pressure index (ABI), without signs of rest pain, ulcer, or gangrene, and without prior lower extremity revascularization procedures. The main outcome measures were changes in physical functioning, community walking distance, bodily pain, leg symptoms, and ABI. Results: Of the 526 study patients, 20% underwent revascularization procedures (60 surgical bypass grafting and 44 angioplasty only). The mean ABI improved significantly for the patients who underwent bypass grafting surgery (0.20; P < .001) and modestly for the patients who underwent angioplasty (0.09; P < .05). Patients undergoing bypass grafting and angioplasty maintained highly significant (P < .001) improvements in mean physical functioning, (17%, 14%), bodily pain (18%, 13%), and walking distance (28%, 27%) scores and reported greater leg symptom improvement. The results were far superior for the patients with greater improvement in ABI. The conditions of the 277 unmatched patients who underwent medical management declined on all outcome measures, and the conditions of the 145 matched patients who underwent medical management improved 5% (P < .001) on walking distance score. Eighteen percent of the study patients failed to complete the full study follow-up period. Conclusion: Most of the functional improvement achieved by patients who underwent interventional management appears to be related to improved patency rather than to selection bias or placebo effects. The functional gains were approximately half those often reported for patients for hip arthroplasty and similar to patients who undergo elective coronary angioplasty.

Original languageEnglish (US)
Pages (from-to)93-103
Number of pages11
JournalJournal of Vascular Surgery
Volume31
Issue number1 I
DOIs
StatePublished - 2000

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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