Quality of Life in Chronic Limb Threatening Ischaemia: Systematic Review and Meta-Analysis

Leonard L Shan; Linda S Yang; Michelle Tew; Mark J Westcott; Tim D Spelman; Peter F Choong; Alun H Davies

doi:10.1016/j.ejvs.2022.07.051

Quality of Life in Chronic Limb Threatening Ischaemia: Systematic Review and Meta-Analysis

Eur J Vasc Endovasc Surg. 2022 Dec;64(6):666-683. doi: 10.1016/j.ejvs.2022.07.051. Epub 2022 Aug 8.

Authors

Leonard L Shan¹, Linda S Yang², Michelle Tew³, Mark J Westcott⁴, Tim D Spelman⁴, Peter F Choong⁴, Alun H Davies⁵

Affiliations

¹ Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia. Electronic address: leonard.shan3001@gmail.com.
² Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
³ Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
⁴ Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
⁵ Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.

PMID: 35952907
DOI: 10.1016/j.ejvs.2022.07.051

Abstract

Objective: To assess the comparative effectiveness and temporal changes in quality of life (QoL) outcomes after revascularisation, major lower extremity amputation (MLEA), and conservative management (CM) in chronic limb threatening ischaemia (CLTI).

Data sources: MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science.

Review methods: A systematic review and meta-analysis were performed on QoL measured by any QoL instrument in adult patients with CLTI after open surgery (OS), endovascular intervention (EVI), MLEA, or CM. Randomised controlled trials and prospective observational studies published in any language between 1 January 1990 and 21 May 2021 were included. There was a pre-specified measurement time point of six months. Random effects meta-analysis was conducted on total scores for each QoL instrument. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach (PROSPERO registration: CRD42021253953).

Results: Fifty-five studies with 8 909 patients were included. There was significant heterogeneity in the methods used to measure QoL, and the study characteristics. In particular, 14 different QoL instruments were used with various combinations of disease specific and generic instruments within each study. A narrative summary is therefore presented. Comparative effectiveness data showed there was reasonable certainty that QoL was similar between OS and EVI at six months. Temporal outcomes suggested small to moderate improvements in QOL six months after OS and EVI compared with baseline. Limited data indicated that QoL can be maintained or slightly improved after MLEA or CM. Treatment effects were overestimated owing to small study effects, selective non-reporting, attrition, and survivorship bias.

Conclusion: QoL after OS and EVI appears to be similar. Revascularisation may provide modest QoL benefits, while MLEA or CM can maintain QoL. However, certainty of evidence is generally low or very low, and interpretation is hampered by significant heterogeneity. There is a need for a CLTI specific QoL instrument and methodological standardisation in QoL studies.

Keywords: Chronic limb threatening ischaemia; Critical limb ischaemia; Peripheral arterial disease; Quality of life; Systematic review.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Amputation, Surgical
Chronic Limb-Threatening Ischemia*
Conservative Treatment
Humans
Observational Studies as Topic
Quality of Life*
Vascular Surgical Procedures