Quality of life and exercise performance after aortoiliac stent placement for claudication.
OBJECTIVE
To determine the effect of aortoiliac stent placement on walking ability and health-related quality of life (QOL) for elderly individuals with moderate to severe intermittent claudication.


METHODS
A prospective single-center study was performed in 35 consecutive patients (46 symptomatic limbs) with intermittent claudication and aortoiliac insufficiency (mean age+/-SD, 61.1 years+/-9.5). Baseline and follow-up data to 12 months included clinical status, ankle-brachial index (ABI), exercise performance according to a standardized treadmill exercise protocol, and self-reported health-related QOL according to the Walking Impairment Questionnaire (WIQ) and the Short Form 36 (SF-36).


RESULTS
Comparing baseline with 12-month data, mean ABI significantly improved from 0.64+/-0.15 to 0.89+/-0.19 (P<.01). Similarly, mean initial claudication duration improved from 1.7 minutes+/-1.0 to 4.7 minutes+/-3.3 and maximum walking duration on the treadmill test improved from a mean of 3.3 minutes+/-1.8 to 8.7 minutes+/-4.4. All WIQ subscales showed significant improvement, and the SF-36 physical component scale as well as subscales of physical functioning, bodily pain, role physical, and vitality showed significant improvement. There was no 30-day mortality. Complications in the perioperative period that required treatment were observed in three patients (9%), but surgery was not required for any complications. Importantly, urgent or emergent surgery was not required for any complication and no permanent disability related to complications occurred.


CONCLUSIONS
A high technical success rate (97%) and low complication rate were observed. Exercise performance and health-related QOL results improved significantly after stent placement. Revascularization with stent placement should be strongly considered in addition to conservative management for moderate to severe claudication with aortoiliac obstruction. A randomized clinical trial would be needed to gauge the relative effectiveness of stent implantation and conservative therapy.
Division of Vascular and Interventional Radiology, Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island 02903, USA. tmurphy@lifespan.org
Timothy P
TP
Murphy
Gregory M
GM
Soares
H Myra
HM
Kim
Sun H
SH
Ahn
Richard A
RA
Haas
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007083:Iliac Artery; D007383:Intermittent Claudication / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D015607:Stents; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016138:Walking