title: A prospective study of the effect of limb-threatening ischaemia and its surgical treatment on the quality of life.
abstract: OBJECTIVE
  To assess the quality of life after treatment for limb-threatening ischaemia.
  
  
  METHODS
  An open, prospective, observational study in a Vascular Unit of a University Hospital.
  
  
  METHODS
  One hundred and fifty consecutive patients presenting with actual or threatened tissue loss of the leg.
  
  
  METHODS
  A single, experienced observer assessed the patients for pain, mobility, anxiety, depression, self-care and lifestyle at presentation, 6 and 12 months later.
  
  
  RESULTS
  Six different treatment outcomes were recognised: successful angioplasty, successful thrombolysis/thrombectomy, successful surgical bypass, amputation after failed revascularisation, primary unilateral amputation and primary bilateral amputation. Pain was significantly improved in all groups (p < 0.05) except for patients after failed revascularization (p = 0.08). Mobility improved in patients who underwent angioplasty (p = 0.05) or a successful surgical bypass (p = 0.001). Anxiety and depression both improved significantly only after surgical reconstruction (p < 0.02). Self-care ability improved significantly after angioplasty (p < 0.05), surgical reconstruction (p < 0.005) and unilateral primary amputation (p < 0.05), but was unaltered in the other groups. Lifestyle significantly deteriorated following thrombolysis/thrombectomy and failed surgical reconstruction (p < 0.05), but was maintained in all other groups.
  
  
  CONCLUSIONS
  The treatment of limb-threatening ischaemia should aim to maintain pre-morbid lifestyle, an aim which is best achieved by limb-salvage. The patient's own expectations and needs have a major bearing on the choice of therapy.
authors.affiliation: Department of Vascular Surgery, Royal Hallamshire Hospital, Sheffield, U.K.
authors.forename: B F
authors.initials: BF
authors.lastname: Johnson
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.forename: L
authors.initials: L
authors.lastname: Evans
authors.forename: R
authors.initials: R
authors.lastname: Drury
authors.forename: D
authors.initials: D
authors.lastname: Datta
authors.forename: J D
authors.initials: JD
authors.lastname: Beard
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D017130:Angioplasty; D001007:Anxiety / Q000209:etiology; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D016022:Case-Control Studies; D003863:Depression / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000523:psychology* / Q000534:rehabilitation / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome