Do age and comorbidity affect quality of life or PTA-induced quality-of-life improvements in patients with symptomatic PAD?

Purpose: To elucidate whether age or comorbidity influences (1) quality of life (QoL) or (2) the gain in QoL due to percutaneous angioplasty procedures in symptomatic peripheral arterial disease (PAD) patients. Methods: One hundred two consecutive patients (81 men; mean age 66.3 +/- 9.1 years, range 44-83) with symptomatic PAD (83.2% with intermittent claudication, 16.8% with chronic critical limb ischemia) were testedcross-sectionally for their self-reported QoL and degree of leg pain during walking or rest according to standardized scales. A subgroup of 48 patients with a comparable clinical profile was prospectively investigated before and shortly after angioplasty. Quantitative indices of comorbidity burden and hemodynamic parameters were also obtained. Results: QoL impairment significantly increased with a greater comorbidity burden and greater degree of leg pain during exercise or at rest, but decreased with advancing age (R=0.91, p < 0.0001, stepwise regression). The angioplasty-associated gain in QoL, however, was positively correlated with the initial degree of QoL impairment and the degree of improvement in intermittent claudication (R=0.873, p < 0.0001, multiple regression). By contrast, neither age nor comorbidity burden adversely affected angioplasty-induced QoL improvements. Conclusions: PAD patients with higher levels of leg pain or a greater comorbidity burden generally have more pronounced QoL impairment. They can gain considerable QoL benefits from percutaneous procedures, especially if they have greater QoL impairment initially, and experience substantial improvements in exertional leg pain after treatment. In general, neither age nor comorbidity should negatively influence the decision for percutaneous therapy in symptomatic PAD patients.