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Quality of Life after Femorocrural Bypass in CLTI: A Double-Center Study Utilizing the SF-36 Questionnaire
Apostolos G Pitoulias1, Maria Louvrou1, Mathias Wilhelmi2
1Department of Vascular and Endovascular Surgery, St. Bernward Hospital, Hildesheim, Germany.
Insights
Femorocrural bypass surgery significantly improves quality of life (QoL) for patients with chronic limb-threatening ischemia (CLTI). This treatment enhances both physical and mental well-being, offering holistic benefits beyond traditional clinical outcomes.
Area of Science:
- Vascular Surgery
- Patient-Reported Outcomes
- Peripheral Arterial Disease
Background:
- Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral arterial disease.
- CLTI can lead to amputation, severely impacting patient quality of life (QoL).
- Femorocrural bypass is a standard treatment, but its effect on QoL requires further investigation.
Purpose of the Study:
- To evaluate the impact of femorocrural bypass surgery on the QoL of CLTI patients.
- To assess changes in physical and mental QoL using the SF-36 questionnaire.
- To compare QoL outcomes with traditional surgical metrics.
Main Methods:
- Prospective, double-center study of 34 CLTI patients undergoing femorocrural bypass.
- SF-36 questionnaire used for QoL assessment at multiple time points (preoperative, discharge, 1- and 3-month follow-up).
- Primary endpoints: changes in physical and mental QoL; Secondary endpoints: patency, amputation, mortality, and foot pulses.
Main Results:
- Significant improvements observed across all SF-36 QoL subscales over time.
- Mental health and physical role limitations showed delayed but significant improvement.
- Achieved 93.3% primary patency, with low amputation (33.3% minor, 6.7% major) and 11.8% mortality rates.
Conclusions:
- Femorocrural bypass surgery substantially enhances both physical and mental QoL in CLTI patients.
- QoL assessment is crucial for evaluating the comprehensive benefits of CLTI surgical treatments.
- The procedure offers significant holistic advantages beyond conventional clinical endpoints.
Background:
Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral arterial disease and often leads to amputation limiting the quality of life (QoL) of patients. While femorocrural bypass is an established treatment for CLTI, its impact on patient's QoL has not been thoroughly researched.
Methods:
This prospective, double-center study evaluated 34 patients undergoing femorocrural bypass for the treatment of CLTI utilizing the SF-36 questionnaire. QoL assessments were conducted preoperatively, at discharge, and at 1- and 3-month follow-up, respectively. Primary endpoints included changes in physical and mental QoL. Secondary endpoints included traditional metrics such as primary patency, minor and major amputation, mortality, and palpable foot pulses.
Results:
Significant improvement was observed across all SF-36 subscales over time,. While most subscales improved consistently, mental health showed delayed recovery, reaching significance only at later stages. Similar result was also observed for role limitations due to physical health, which improved only after discharge. The study documented a primary patency rate of 93.3%, minor and major amputation rates of 33.3% and 6.7%, and a mortality rate of 11.8%. Postoperative palpable foot pulses were present in 46.7% of patients.
Conclusion:
Femorocrural bypass surgery for CLTI significantly improves both physical and mental aspects of QoL. These findings highlight the importance of incorporating QoL assessments into outcome measures of surgical treatment of CLTI and underscore the procedure's holistic benefit beyond traditional clinical endpoints.
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