Quality of life in patients suffering from critical limb ischemia

Objective: Various treatment options exist for patients suffering from critical limb ischemia (CLI). These options consist of endovascular procedures, surgical revascularization, primary amputation or conservative therapy. The effect of the treatment is traditionally focused on outcomes such as primary patency and limb salvage, though quality of life (QoL) is considered an important additional primary endpoint in a more patient-oriented healthcare system. The aim of this systematic review is to explore the best clinical decision making possible, to increase QoL in CLI patients. Methods: This review is based on a systematic electronic literature search using the PubMed and EMBASE databases. Articles evaluating QoL in patients with CLI were selected for further analysis. Only prospective studies, written in English, describing QoL and health status (HS) after endovascular or surgical revascularization, amputation or conservative therapy were considered for inclusion. Treatment results were divided into short-term (≤3 months follow-up) and long-term results (≥1 year follow-up) to achieve a clear view of the QoL in patients suffering for CLI patients. Results: Twenty-five articles describing health status (HS) in patients suffering from CLI were included. It was found that while most of these articles reported HS of patients, rarely did they report on QoL. As result it is difficult to determine the best treatment to increase HS as studies that focus on the comparison of treatment modalities are lacking. All four treatment modalities can raise HS in the short and the long-term, however endovascular and surgical revascularization seem to positively effect HS the most. QoL results are lacking in both the short- and long-term. Conclusion: All treatment methods included in the study resulted in an increase in patients' HS in both short- and long-term. More comparative studies with inclusion of all different treatments of CLI are needed to assist in clinical decision-making and perform tailored interventions for the individual patient. QoL and HS are confusingly used in current international literature with abundant HS research. To take patients individual opinions more into account, focus on QoL research is needed to designate the superior treatment in patients suffering from CLI