Khalil Emced, Ozcan Sedat
Dr. Emced Khalil Department of Cardiovascular Surgery, Ordu University Research and Education Hospital, Ordu, Turkey.
Dr. Sedat Ozcan Department of Cardiovascular Surgery. Canakkale 18 Mart University Faculty of Medicine, Canakkale, Turkey.
Pak J Med Sci. 2020 Jul-Aug;36(5):877-883. doi: 10.12669/pjms.36.5.2680.
BACKGROUND & OBJECTIVE: Revascularization of the target vessel and restoration of distal flow is critical not only to reduce mortality and morbidity but also improve health-related quality of life (HRQoL) in patients with critical limb ischemia. However, data concerning the impact of surgical bypass and percutaneous transluminal angioplasty (PTA) on HRQoL is limited. This study aimed to compare the impact of surgical bypass and PTA on HRQoL in subjects undergoing superficial femoral artery (SFA) or popliteal artery revascularization.
Seventy-one subjects who underwent successful revascularization of the SFA or popliteal artery either with surgical revascularization or PTA were enrolled in this study. Three months after revascularization, all subjects underwent ankle-brachial index (ABI) measurement, 6-minute walking test and completed the Nottingham Health Profile (NHP) questionnaire. The NHP score differences (measured at the post-procedural 3 month) between subjects undergoing surgical or endovascular (PTA) revascularization subjects was the primary outcome measure of the study.
Both groups experienced significant improvements in ABI and 6-minute walking distance at post-procedure three months. NHP total scores of Part I and Part II at post-procedural six months were similar in the two groups. However, social isolation [77.98 (0 - 85) vs. 22.53 (0 - 100), p=0.002] and physical abilities [78.7 (30.31 - 87.7) vs. 54.47 (0 - 100), P=0.014] domain scores of the surgical revascularization group were significantly higher than that of the endovascular treatment group.
This study shows that total scores obtained from the NHP questionnaire applied three months after revascularization of SFA stenosis are similar in subjects undergoing surgical revascularization or PTA. However, the social isolation and physical abilities domains of the NHP are significantly higher in subjects receiving surgical revascularization compared to those receiving PTA.
对于严重肢体缺血患者，靶血管血运重建及远端血流恢复不仅对于降低死亡率和发病率至关重要，而且对于改善健康相关生活质量（HRQoL）也很关键。然而，关于外科搭桥和经皮腔内血管成形术（PTA）对HRQoL影响的数据有限。本研究旨在比较外科搭桥和PTA对接受股浅动脉（SFA）或腘动脉血运重建患者HRQoL的影响。
本研究纳入了71例成功接受SFA或腘动脉外科血运重建或PTA的患者。血运重建后3个月，所有患者均接受踝肱指数（ABI）测量、6分钟步行试验，并完成诺丁汉健康量表（NHP）问卷。外科或血管内（PTA）血运重建患者之间在术后3个月时的NHP评分差异是本研究的主要结局指标。
两组患者在术后3个月时ABI和6分钟步行距离均有显著改善。两组患者术后6个月时NHP第一部分和第二部分的总分相似。然而，外科血运重建组的社交孤立[77.98（0 - 85）对22.53（0 - 100），p = 0.002]和身体能力[78.7（30.31 - 87.7）对54.47（0 - 100），P = 0.014]领域评分显著高于血管内治疗组。
本研究表明，SFA狭窄血运重建后3个月应用NHP问卷获得的总分在接受外科血运重建或PTA的患者中相似。然而，与接受PTA的患者相比，接受外科血运重建的患者NHP的社交孤立和身体能力领域评分显著更高。
