title: Depression is associated with worse patency and recurrent leg symptoms after lower extremity revascularization.
abstract: OBJECTIVE
  Depression is associated with worse outcomes after coronary artery bypass surgery, but its association with the results after revascularization for symptomatic peripheral arterial disease (PAD) is unknown. This study assessed the association between depression and patency, recurrent symptoms, and limb salvage after revascularization for symptomatic PAD.
  
  
  METHODS
  Electronic medical records were retrospectively reviewed for all patients with symptomatic PAD who underwent intervention (open, endovascular, or combined) between January 2000 and October 2004. All patients were previously screened for depression, and treatment was initiated as indicated by the primary care physician or psychiatrist. Demographic data and outcomes were recorded using published guidelines. Outcomes of interest included primary patency of the revascularization (bypass graft or angioplasty/stented artery), assisted primary patency, secondary patency, recurrent symptomatic ipsilateral PAD, and major amputation. Follow-up was available for all patients (mean, 23.4 +/- 14.1 months).
  
  
  RESULTS
  Board-certified vascular surgeons performed all interventions. At the time of intervention, 78 (36.1%) of 216 patients had been diagnosed with depression. Compared with those without depression, depressed patients were younger (64.4 vs 69.1 years; P = .001), currently using tobacco (74.4% vs 51.4%; P = .001), and less likely to have hypertension (79.5% vs 89.9%; P = .03). No other significant differences were noted for cardiovascular risk factors or prevalent comorbidities. During follow-up, 50 patients (23.1%) had failing or failed revascularizations, and 24 (11%) had amputations. Those with depression at the time of the PAD intervention, compared at 24 months with patients without depression, had significantly worse primary patency (58.2% vs 79.8%; P = .02), primary assisted patency (59.5% vs 81.5%; P = .01), and secondary patency (60.2% vs 82.2%; P = .007). They also had a significantly increased risk of recurrent symptomatic PAD (33.7% vs 20.8%; P = .03) but not major amputation (13.8% vs 10.4%; P = .73). By multivariate analysis, patients with depression were at significantly increased risk for recurrent symptomatic PAD (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.03 to 3.02; P = .04) and failure of revascularization (HR, 2.18; 95% CI, 1.22 to 3.88; P < .01), but not major amputation.
  
  
  CONCLUSIONS
  Depression is common among patients undergoing intervention for symptomatic PAD. After intervention, patients with depression have worse outcomes for the affected leg. Prospective analysis is required to confirm these results.
authors.affiliation: Division of Vascular Surgery, State University of New York at Buffalo, Buffalo, NY 14203, USA. gcherr@buffalo.edu <gcherr@buffalo.edu>
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cherr
authors.forename: Jiping
authors.initials: J
authors.lastname: Wang
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Zimmerman
authors.forename: Hasan H
authors.initials: HH
authors.lastname: Dosluoglu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage / Q000379:methods* / Q000706:statistics & numerical data; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology* / Q000601:surgery; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*