Ability to work after arterial surgery for chronic incapacitating ischaemia of the lower limb in middle-aged patients.
OBJECTIVE
To assess the efficacy of arterial surgery in restoring ability to walk and working capacity.


METHODS
Retrospective follow up study.


METHODS
Fourth Department of Surgery, Helsinki University Central Hospital.


METHODS
67 middle-aged patients (mean age 53 years) with chronic incapacitating ischaemia of the lower limb.


METHODS
Arterial reconstruction.


METHODS
Clinical outcome, vascular laboratory assessments, mortality, morbidity, return to work, and retirement.


RESULTS
According to objective vascular laboratory criteria a primary positive effect was achieved in 63/67 (94%). Fourty-eight of the 65 surviving patients (74%) were free of symptoms on treadmill testing three months after the operation. Working capacity was restored in 41/50 of the patients not yet retired (82%). Three years postoperatively 77% of the surviving patients still fared objectively better than before operation. The 10-year survival rate was 67%. Fourteen of the 22 patients who died did so of cardiovascular diseases (64%). Advanced distal ischaemia (indicated by a preoperative ankle-brachial index of 0.5 or less) was associated with increased risk of death. Altogether 251 working years were achieved of the 435 that could have potentially been gained. The most common reason for retirement during follow up was progression of peripheral arterial disease in the lower limbs in 13/41 patients (32%). At the end of the study there were nine patients still working with potentially 73 working years left.


CONCLUSIONS
These results indicate that arterial surgery can restore working capacity in middle aged patients with threatening or temporary invalidity. Long term outcome, especially mortality, is mostly affected by other signs of cardiovascular disease, whereas working capacity is dependent on a wider variety of factors.
Peräkylä
T K
TK
Fourth Department of Surgery, Helsinki University Central Hospital, Finland.
Lepäntalo
M
M
Lassila
R
R
Pietilä
J A
JA
Lindfors
O
O
D000328:Adult; D001158:Arteries / Q000601:surgery; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014938:Work Capacity Evaluation