LIBERTY 360 shows quality-of-life improvements after peripheral vascular intervention

Quality of life (QoL) improved significantly and sustainably in patients with peripheral artery disease (PAD) after lower extremity endovascular intervention. Moreover, the prospective, observational, multicentre LIBERTY 360 study demonstrated that baseline health status and disease severity were the strongest predictors for QoL improvement after the intervention [1].

QoL improvement is a valid indication for peripheral vascular intervention in patients with PAD [2]. However, Dr Mohsin Chowdhury (Harvard Medical School, MA, USA) pointed out that evidence was lacking regarding the long-term QoL improvements and predictors of QoL improvement after peripheral vascular intervention. The multicentre, prospective LIBERTY 360 study (NCT01855412) hypothesised that surgical intervention is related to significant and sustained improvement in QoL. Furthermore, the authors predicted an inverse association between disease severity and QoL improvements. In total, 1,204 patients who underwent lower extremity endovascular intervention were followed for up to 5 years. The European Quality of Life Scale (EuroQoL) EQ-5D-5L and the Vascular Quality of Life Questionnaire (VascuQol-25) were assessed. For the analysis, participants were categorised as patients with claudication (Rutherford classification 2–3) or patients with critical limb ischaemia (Rutherford classification 4–6).

In patients with claudication, EuroQol scores displayed an improved and mostly sustained QoL at 30 days (mean delta EQ-VAS +6.3), 12 months (+5.4), and 36 months (+3.4) after surgery, compared with baseline QoL (mean EQ-VAS 68.8). A similar pattern was observed in patients with critical limb ischaemia: mean baseline EQ-VAS 64.2 and at 30 days (+4.6), 12 months (+6.5), and 36 months (+3.5). The VascuQoL-25 scores (see Figure) demonstrated that surgery resulted in a minimal important difference in QoL in 56.7% of the patients with claudication after 30 days. Respectively, 52.9% and 53.5% of the patients displayed a minimal important difference in QoL after 12 months and 36 months. In patients with critical limb ischaemia, the corresponding percentages were 50.8% (30 days), 59.1% (12 months), and 57.7% (36 months).

Figure: Quality of life improvements in claudication and critical limb ischaemia [1]



The authors reported that patients with no/slight QoL problems at baseline were more likely to experience QoL improvements after surgery than patients with moderate/severe QoL problems at baseline (OR 4.81; P<0.0001). In addition, critical limb ischaemia (OR 0.61; P=0.0021), female sex (OR 0.64; P=0.0081), a history of renal disease (OR 0.56; P=0.0006), or a history of previous lower limb endovascular treatment (OR 0.70; P=0.0286) were associated with fewer QoL improvements after surgery.

 

1. 
   
   1. Chowdhury M, et al. Long term quality of life improvement after peripheral vascular intervention: insights from the LIBERTY 360 study. VA.AOS.427, AHA 2021 Scientific Sessions, 13­–15 November.
   2. Gerhard-Herman MD, et al. 2017;135(12):e726-e779.

 

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Posted on 14 January 20227 February 2024