Quality of life and traditional outcome results at 1 year in elderly patients having critical limb ischemia and the role of conservative treatment

Stijn L. Steunenberg*, Jolanda de Vries, Jelle W. Raats, Nathalie Verbogt, Paul Lodder, Geert-Jan van Eijck, Eelco J. Veen, Hans G. W. de Groot, Gwan H. Ho, Lijckle van der Laan

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Introduction: 

Revascularization is the cornerstone of the treatment of critical limb ischemia (CLI), but the number of elderly frail patients increase. Revascularization is not always possible in these patients and conservative therapy seems to be an option. The goals of this study are to analyze the 1-year quality of life (QoL) results and mortality rates of elderly patients with CLI and to investigate if conservative treatment could be an acceptable treatment option. 

Methods: 

Patients with CLI >= 70 years old were included in a prospective observational cohort study in 2 hospitals in the Netherlands between 2012 and 2016 and were divided over 3 treatment modalities: endovascular therapy, surgical revascularization, and conservative treatment. The World Health Organization Quality of Life (WHOQoL-Bref) instrument, a generic QoL assessment tool that includes components of physical, psychological, social relationships and environment, was used to evaluate QoL at baseline, 6 months, and 1 year. 

Results: 

In total, 195 patients (56% male, 33% Rutherford 4, mean age of 80) were included. Physical QoL significantly increased after surgical (10.4 vs 14.9, P <.001), endovascular (10.9 vs 13.7, P <.001), and conservative therapy (11.6 vs 13.2, P = .01) at 1 year. One-year mortality was relatively low after surgery (10%) compared to endovascular (40%) and conservative therapy (37%). 

Conclusion: 

The results of this study could not be used to designate the superior treatment used in elderly patients with CLI. Conservative treatment could be an acceptable treatment option in selected patients with CLI unfit for revascularization. Treatment of choice in elderly patients with CLI is based on multiple factors and should be individualized in a shared decision-making process.

Original languageEnglish
Pages (from-to)126-134
JournalVascular and endovascular surgery
Volume54
Issue number2
DOIs
Publication statusPublished - 2019

Keywords

  • quality of life
  • critical limb ischemia
  • conservative therapy
  • elderly patients
  • TREATMENT STRATEGIES
  • DOUBLE-BLIND
  • REVASCULARIZATION
  • TRIAL
  • MULTICENTER
  • MANAGEMENT
  • AMPUTATION
  • MORTALITY
  • BYPASS
  • RISK

Cite this

Steunenberg, Stijn L. ; de Vries, Jolanda ; Raats, Jelle W. ; Verbogt, Nathalie ; Lodder, Paul ; van Eijck, Geert-Jan ; Veen, Eelco J. ; de Groot, Hans G. W. ; Ho, Gwan H. ; van der Laan, Lijckle. / Quality of life and traditional outcome results at 1 year in elderly patients having critical limb ischemia and the role of conservative treatment. In: Vascular and endovascular surgery. 2019 ; Vol. 54, No. 2. pp. 126-134.
@article{b4ae59b443364eddb2468c0a8031fb0c,
title = "Quality of life and traditional outcome results at 1 year in elderly patients having critical limb ischemia and the role of conservative treatment",
abstract = "Introduction: Revascularization is the cornerstone of the treatment of critical limb ischemia (CLI), but the number of elderly frail patients increase. Revascularization is not always possible in these patients and conservative therapy seems to be an option. The goals of this study are to analyze the 1-year quality of life (QoL) results and mortality rates of elderly patients with CLI and to investigate if conservative treatment could be an acceptable treatment option. Methods: Patients with CLI >= 70 years old were included in a prospective observational cohort study in 2 hospitals in the Netherlands between 2012 and 2016 and were divided over 3 treatment modalities: endovascular therapy, surgical revascularization, and conservative treatment. The World Health Organization Quality of Life (WHOQoL-Bref) instrument, a generic QoL assessment tool that includes components of physical, psychological, social relationships and environment, was used to evaluate QoL at baseline, 6 months, and 1 year. Results: In total, 195 patients (56{\%} male, 33{\%} Rutherford 4, mean age of 80) were included. Physical QoL significantly increased after surgical (10.4 vs 14.9, P <.001), endovascular (10.9 vs 13.7, P <.001), and conservative therapy (11.6 vs 13.2, P = .01) at 1 year. One-year mortality was relatively low after surgery (10{\%}) compared to endovascular (40{\%}) and conservative therapy (37{\%}). Conclusion: The results of this study could not be used to designate the superior treatment used in elderly patients with CLI. Conservative treatment could be an acceptable treatment option in selected patients with CLI unfit for revascularization. Treatment of choice in elderly patients with CLI is based on multiple factors and should be individualized in a shared decision-making process.",
keywords = "quality of life, critical limb ischemia, conservative therapy, elderly patients, TREATMENT STRATEGIES, DOUBLE-BLIND, REVASCULARIZATION, TRIAL, MULTICENTER, MANAGEMENT, AMPUTATION, MORTALITY, BYPASS, RISK",
author = "Steunenberg, {Stijn L.} and {de Vries}, Jolanda and Raats, {Jelle W.} and Nathalie Verbogt and Paul Lodder and {van Eijck}, Geert-Jan and Veen, {Eelco J.} and {de Groot}, {Hans G. W.} and Ho, {Gwan H.} and {van der Laan}, Lijckle",
year = "2019",
doi = "10.1177/1538574419885478",
language = "English",
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issn = "1538-5744",
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Quality of life and traditional outcome results at 1 year in elderly patients having critical limb ischemia and the role of conservative treatment. / Steunenberg, Stijn L.; de Vries, Jolanda; Raats, Jelle W.; Verbogt, Nathalie; Lodder, Paul; van Eijck, Geert-Jan; Veen, Eelco J.; de Groot, Hans G. W.; Ho, Gwan H.; van der Laan, Lijckle.

In: Vascular and endovascular surgery, Vol. 54, No. 2, 2019, p. 126-134.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Quality of life and traditional outcome results at 1 year in elderly patients having critical limb ischemia and the role of conservative treatment

AU - Steunenberg, Stijn L.

AU - de Vries, Jolanda

AU - Raats, Jelle W.

AU - Verbogt, Nathalie

AU - Lodder, Paul

AU - van Eijck, Geert-Jan

AU - Veen, Eelco J.

AU - de Groot, Hans G. W.

AU - Ho, Gwan H.

AU - van der Laan, Lijckle

PY - 2019

Y1 - 2019

N2 - Introduction: Revascularization is the cornerstone of the treatment of critical limb ischemia (CLI), but the number of elderly frail patients increase. Revascularization is not always possible in these patients and conservative therapy seems to be an option. The goals of this study are to analyze the 1-year quality of life (QoL) results and mortality rates of elderly patients with CLI and to investigate if conservative treatment could be an acceptable treatment option. Methods: Patients with CLI >= 70 years old were included in a prospective observational cohort study in 2 hospitals in the Netherlands between 2012 and 2016 and were divided over 3 treatment modalities: endovascular therapy, surgical revascularization, and conservative treatment. The World Health Organization Quality of Life (WHOQoL-Bref) instrument, a generic QoL assessment tool that includes components of physical, psychological, social relationships and environment, was used to evaluate QoL at baseline, 6 months, and 1 year. Results: In total, 195 patients (56% male, 33% Rutherford 4, mean age of 80) were included. Physical QoL significantly increased after surgical (10.4 vs 14.9, P <.001), endovascular (10.9 vs 13.7, P <.001), and conservative therapy (11.6 vs 13.2, P = .01) at 1 year. One-year mortality was relatively low after surgery (10%) compared to endovascular (40%) and conservative therapy (37%). Conclusion: The results of this study could not be used to designate the superior treatment used in elderly patients with CLI. Conservative treatment could be an acceptable treatment option in selected patients with CLI unfit for revascularization. Treatment of choice in elderly patients with CLI is based on multiple factors and should be individualized in a shared decision-making process.

AB - Introduction: Revascularization is the cornerstone of the treatment of critical limb ischemia (CLI), but the number of elderly frail patients increase. Revascularization is not always possible in these patients and conservative therapy seems to be an option. The goals of this study are to analyze the 1-year quality of life (QoL) results and mortality rates of elderly patients with CLI and to investigate if conservative treatment could be an acceptable treatment option. Methods: Patients with CLI >= 70 years old were included in a prospective observational cohort study in 2 hospitals in the Netherlands between 2012 and 2016 and were divided over 3 treatment modalities: endovascular therapy, surgical revascularization, and conservative treatment. The World Health Organization Quality of Life (WHOQoL-Bref) instrument, a generic QoL assessment tool that includes components of physical, psychological, social relationships and environment, was used to evaluate QoL at baseline, 6 months, and 1 year. Results: In total, 195 patients (56% male, 33% Rutherford 4, mean age of 80) were included. Physical QoL significantly increased after surgical (10.4 vs 14.9, P <.001), endovascular (10.9 vs 13.7, P <.001), and conservative therapy (11.6 vs 13.2, P = .01) at 1 year. One-year mortality was relatively low after surgery (10%) compared to endovascular (40%) and conservative therapy (37%). Conclusion: The results of this study could not be used to designate the superior treatment used in elderly patients with CLI. Conservative treatment could be an acceptable treatment option in selected patients with CLI unfit for revascularization. Treatment of choice in elderly patients with CLI is based on multiple factors and should be individualized in a shared decision-making process.

KW - quality of life

KW - critical limb ischemia

KW - conservative therapy

KW - elderly patients

KW - TREATMENT STRATEGIES

KW - DOUBLE-BLIND

KW - REVASCULARIZATION

KW - TRIAL

KW - MULTICENTER

KW - MANAGEMENT

KW - AMPUTATION

KW - MORTALITY

KW - BYPASS

KW - RISK

U2 - 10.1177/1538574419885478

DO - 10.1177/1538574419885478

M3 - Article

VL - 54

SP - 126

EP - 134

JO - Vascular and endovascular surgery

JF - Vascular and endovascular surgery

SN - 1538-5744

IS - 2

ER -