TY - JOUR
T1 - Functional status and walking ability after lower extremity bypass grafting or angioplasty for intermittent claudication
T2 - Results from a prospective outcomes study
AU - Feinglass, Joe
AU - McCarthy, Walter J.
AU - Slavensky, Rael
AU - Manheim, Larry M.
AU - Martin, Gary J.
N1 - Funding Information:
This research was supported by Grant HS 07164 from the US Agency for Health Care and Policy Research to Northwestern University Medical School.
PY - 2000
Y1 - 2000
N2 - 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.
AB - 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.
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U2 - 10.1016/S0741-5214(00)70071-1
DO - 10.1016/S0741-5214(00)70071-1
M3 - Article
C2 - 10642712
AN - SCOPUS:0033985694
SN - 0741-5214
VL - 31
SP - 93
EP - 103
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 1 I
ER -