Functional status and walking ability after lower extremity bypass grafting or angioplasty for intermittent claudication: Results from a prospective outcomes study
Functional status and walking ability after lower extremity bypass grafting or angioplasty for intermittent claudication: Results from a prospective outcomes study
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DOI：
10.1016/s0741-5214(00)70071-1
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发表时间：
2000-01-01
影响因子：
4.3
通讯作者：
Martin, GJ
中科院分区：
文献类型：
--
作者：
Feinglass, J;McCarthy, WJ;Martin, GJ
目的：本研究的目的是下肢旁路移植术，血管成形术，或医疗管理的间歇性claudiation.Methods的功能结果的前瞻性比较：本研究被设计为一个前瞻性队列研究，比较功能的干预管理患者的医疗管理，包括一个匹配的（年轻，更多的残疾）亚组，平均为19个月。芝加哥地区的16家血管外科诊所参与了这项研究。受试者是连续入组的踝臂血压指数（ABI）异常、无静息痛、溃疡或坏疽体征且既往未接受过下肢血运重建术的患者;。主要结果的措施是身体功能的变化，社区步行距离，身体疼痛，腿部症状，和ABI.Results：在526名研究患者中，20%接受了血运重建手术（60例手术旁路移植术和44例血管成形术）。接受旁路移植术的患者的平均ABI显著改善（0.20; P <0.001），接受血管成形术的患者的平均ABI略有改善（0.09; P <0.05）。接受旁路移植术和血管成形术的患者在平均身体功能（17%，14%）、身体疼痛（18%，13%）和步行距离（28%，27%）评分方面保持了高度显著（P <0.001）的改善，并报告了更大的腿部症状改善。对于ABI改善较大的患者，结果远优于上级。277例接受药物治疗的不匹配患者的所有结局指标均下降，145例接受药物治疗的匹配患者的步行距离评分改善了5%（P < .001）。百分之十八的研究患者未能完成完整的研究follow-up periods.Conclusion：大多数功能的改善，患者接受介入治疗似乎与改善通畅性，而不是选择偏倚或安慰剂效应。髋关节置换术患者的功能改善约为通常报告的一半，与接受择期冠状动脉成形术的患者相似。
Objective: The purpose of this study was the prospective comparison of functional outcomes after lower extremity bypass grafting surgery, angioplasty, or medical management of intermittent claudication.Methods: The study was designed as a prospective cohort study to compare functional outcomes for patients with interventional management to medical management, including a matched (younger, with more disability) subgroup, followed for a mean of 19 months. Sixteen Chicago-area vascular surgery clinics participated in the study. The subjects were consecutively enrolled patients with an abnormal ankle-brachial blood pressure index (ABI), without signs of rest pain, ulcer, or gangrene, and without prior lower extremity revascularization procedures;. The main outcome measures were changes in physical functioning, community walking distance, bodily pain, leg symptoms, and ABI.Results: Of the 526 study patients, 20% underwent revascularization procedures (60 surgical bypass grafting and 44 angioplasty only). The mean ABI improved significantly for the patients who underwent bypass grafting surgery (0.20; P < .001) and modestly for the patients who underwent angioplasty (0.09; P < .05). Patients undergoing bypass grafting and angioplasty maintained highly significant (P < .001) improvements in mean physical functioning, (17%, 14%), bodily pain (18%, 13%), and walking distance (28%, 27%) scores and reported greater leg symptom improvement. The results were far superior for the patients with greater improvement in ABI. The conditions of the 277 unmatched patients who underwent medical management declined on all outcome measures, and the conditions of the 145 matched patients who underwent medical management improved 5% (P < .001) on walking distance score. Eighteen percent of the study patients failed to complete the full study follow-up period.Conclusion: Most of the functional improvement achieved by patients who underwent interventional management appears to be related to improved patency rather than to selection bias or placebo effects. The functional gains were approximately half those often reported for patients for hip arthroplasty and similar to patients wine undergo elective coronary angioplasty.