Successful revascularisation not associated with improved functional ability in critical limb ischaemia patients


Technical success in lower limb revascularisation procedures is not necessarily associated with functional dependency recovery, Enrico Cieri, Vascular and Endovascular Surgery Unit, University of Perugia, Hospital S M Misericordia, Perugia, Italy, told delegates at the European Society for Vascular Surgery annual meeting.

“Patient- and society-oriented measures of outcome have a critical role in determining the effectiveness of any treatment in patients with critical limb ischaemia,” Cieri said. “In particular, the impact of an intervention on patient’s dependency and functional performance is relevant but largely unknown. The aim of the study was to investigate whether the limitations encountered in the activities of daily living measured with the Katz Index (KI) in patients with critical limb ischaemia were changed by the treatment.”

During the period 2006–2008, 248 consecutive patients undergoing repair for critical limb ischaemia were investigated with an activities of daily living questionnaire for assessing Katz index before and after a mean of 16.19 months from treatment. Changes in Katz index were stratified by type of treatment and outcome.

There were 165 males and 83 females, mean age 73.3 years; 125 patients showed tissue loss and 123 rest pain alone, 98 received surgical bypass and 150 endovascular repair. At the postoperative assessment there was significant worsening in patients’ functional outcome (mean KI decreased to 9.78) despite relief of pain (81.5%), tissue healing (72%), good vessel patency (83.8%) and low amputation rate (9.7%). Deterioration of KI was not-significantly higher in patients undergoing endovascular repair. Patients receiving major amputation started with worse preoperative functional score (KI mean 9.42) and did further deteriorate (KI mean 7.71) after demolition surgery. However, also patients who received successful revascularization showed deterioration in dependence index.

Cieri told delegates that critical limb ischaemia is a marker of a poor irreversible condition with high functional dependency and limited options for patient health improvement.

“Successful vascular treatment is not associated with improved functional ability in patients with critical limb ischaemia especially when already highly dependent in their activities,” Cieri said. “It should be needed to operate at early stages patients with critical limb ischaemia before severe quality of life deterioration.”