Improving life quality in chronic limb-threatening ischemia through revascularization

A recent publication in the American Heart Association Circulation highlights a comprehensive investigation to assess the impact of revascularization strategies on the health-related quality of life (HRQoL) of patients suffering from chronic limb-threatening ischemia. This study stands as a pivotal exploration into the comparative effectiveness of surgical bypass (Bypass) versus endovascular intervention (Endo) across multiple patient cohorts. Ochsner Health chairman of cardiovascular disease and director of the John Ochsner Heart & Vascular Institute, Dr. Christopher White, was a contributing author on the publication. 

The study categorized patients into two cohorts based on the availability of a single-segment great saphenous vein, which is critical for surgical bypass procedures. HRQoL was assessed using a suite of tools including Vascular Quality-of-Life (VascuQoL), European Quality-of-Life-5D (EQ-5D), the Short Form-12 Physical and Mental Component Summaries (SF-12 PCS & MCS), Utility Index Score (SF-6D R2), and various numeric rating scales of pain. The analysis employed mixed-model linear regression to compare HRQoL outcomes both within and between treatment groups over the duration of the trial.   

The analysis encompassed 1193 patients in cohort 1 and 335 patients in cohort 2, with mean follow-up durations of 2.9 and 2.0 years, respectively. Findings revealed that patients in both cohorts experienced significant improvements in HRQoL from baseline to follow-up across all measures assessed. Notably, in cohort 1, several HRQoL measures favored the Endo group, including VascuQoL, SF-12 MCS, SF-6D R2, and various pain scales. However, these differences, while statistically significant, did not surpass the threshold for clinical meaningfulness. Conversely, no significant differences were observed between the Bypass and Endo groups in cohort 2 on any HRQoL measure.   

Dr. Christopher White, a contributing author to the study, stated, "In patients with chronic limb-threatening ischemia deemed eligible for either Bypass or Endo, revascularization resulted in significant and clinically meaningful improvements in HRQoL. The results of the BEST-CLI trial underscore the profound impact revascularization can have on patients' lives, not just in terms of physical health but also in their overall quality of life. These findings highlight the importance of patient-centered care approaches in vascular surgery and the need for continued innovation in treatment strategies."   

The study unequivocally demonstrates that revascularization—whether through Bypass or Endo—significantly enhances the HRQoL for patients with chronic limb-threatening ischemia. For patients with an available single-segment great saphenous vein, Endo showed slight statistical superiority in some HRQoL measures over Bypass, albeit these differences were not clinically substantial. This finding underscores the effectiveness of revascularization in improving the quality of life for patients facing this severe condition, regardless of the specific intervention applied.   

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Ochsner Health is the leading not-for-profit healthcare provider in the Gulf South, delivering expert care at its 46 hospitals and more than 370 health and urgent care centers. For 12 consecutive years, U.S. News & World Report has recognized Ochsner as the No. 1 hospital in Louisiana. Additionally, Ochsner Children’s has been recognized as the No. 1 hospital for kids in Louisiana for three consecutive years. Ochsner inspires healthier lives and stronger communities through a combination of standard-setting expertise, quality and connection not found anywhere else in the region. In 2023, Ochsner Health cared for more than 1.5 million people from every state in the nation and 65 countries. Ochsner’s workforce includes more than 38,000 dedicated team members and over 4,700 employed and affiliated physicians. To learn more about how Ochsner empowers people to get well and stay well, visit https://www.ochsner.org/.