CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 3, May/June 2014
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AFRICA
namely ASO and Buerger’s disease. This study is therefore the
first to undertake such a comparison.
According to our study, in general, although Buerger’s
disease had a more pronounced negative effect on quality of
life, particularly in terms of pain score, both ASO and Buerger’s
disease impaired quality of life to a similar degree when
critical limb ischaemia was considered. A range of studies have
examined the question of quality of life because it is unclear
which questions best describe quality of life.
11-15
To evaluate
quality of life, we used the SF-36, which has a generic and
general meaning, and the VASCUQOL, which is specific to PAD.
The advantage of generic tests is that they can be used for a
variety of diseases. However, their susceptibility is low, and their
focus on specific effects related to the disease is not good.
16
The
VASCUQOL includes specific questions associated with PAD
and better evaluates the effects after treatment.
17,18
However, to
date, no adequate comparative studies associated with generic
or specific tests have been performed in patients with PAD.
Comparative studies are needed. In the study performed by
Morgan
et al
., these two scores complemented each other and
were compatible.
17
Generally, it follows that when ischaemic lesions become
serious in PAD, quality of life is impaired. In our study, impairment
in the pain component of quality of life in Buerger’s disease
patients was demonstrated. Buerger’s disease patients were more
affected in terms of pain in both the SF-36 and VASCUQOL than
were ASO patients. In an intergroup comparison, a statistically
significant difference was found between the two groups in
terms of pain at the time of hospital admission and at six months.
Pain was identified to be more pronounced in Buerger’s disease
patients; however, this significant difference disappeared at 12
months.
From an evaluation of all the heterogeneous patients included
in this study, who had symptomatology varying from claudication
to ischaemic gangrenes, Buerger’s disease generally impaired
quality of life to a greater extent thanASO. Critical leg ischaemia
was present in only half of the atherosclerotic patients whereas it
was present in almost all of the Buerger’s disease patients.
In order to reduce heterogeneity in the evaluation, quality
of life was evaluated in patients with only critical ischaemia.
The conclusion was reached that the patient groups were not
very different. In other words, when evaluating criteria such as
pain at rest, or presence of ischaemic wound or gangrene, these
conditions affected quality of life negatively, irrespective of
whether they arose from ASO or Buerger’s disease.
Another parameter affecting quality of life was amputation. In
many studies, amputations have been reported to seriously impair
quality of life.
19,20
In the study by Luther,
20
144 patients with critical
ischaemia were evaluated in terms of quality of life, determined
by ankle/brachial index and pain. They also found that single or
multiple amputations did not cause a difference in quality of life.
Amputations were observed to affect morbidity and mortality rates
however, particularly in the eighth and ninth decades.
20
In our study, 23.4% of all patients with ASO and 48.7% of
all patients with Buerger’s disease underwent amputation in the
follow-up period of one year. Throughout the follow up, the
quality of life in patients with amputations was significantly
affected in terms of general health, pain, mental status, physical
function, and emotional and social status in both ASO and
Buerger’s disease patients.
According to the SF-36 score, amputation was observed to
negatively affect pain at the time of admission in both ASO
and Buerger’s disease patients. The quality of life in amputee
patients was evaluated again at the six- and 12-month follow up.
Amputations affected physical function, physical status, pain,
general health, social function and emotional status in both ASO
and Buerger’s disease patients.
When the difference in quality of life between amputee
ASO and Buerger’s disease patients was evaluated with the
VASCUQOL score, we observed no differences between the
two groups, either at the time of hospital admission or at six or
12 months. The interpretation of this result is that because the
source of the pain in patients who had undergone amputation due
to either ASO or Buerger’s disease was removed, no difference
in quality of life would be expected. However, quality of life
was worse in Buerger’s disease patients without amputation
compared with ASO patients.
There are a few limitations to this study. According to our
study, Buerger’s disease affected quality of life more negatively
than ASO, particularly with regard to pain score. Depressive
symptoms are high among patients with PAD. The presence
of depression may be a helpful factor in assessing pain scales
in patients with PAD.
21-23
However, in our study, patients’
psychological conditions were not considered. Assessment of life
of quality may be more effective in PAD patients after treatment
of psychological or emotional disorders.
Another limitation is that the effects of surgical and medical
treatment on quality of life were not evaluated. Furthermore,
as is commonly known, smoking is a highly significant risk
factor for the progression of Buerger’s disease.
24
However
we did not compare quality of life between patients who had
stopped smoking and those who continued to smoke. If the
three parameters: determination of psychological situation, its
treatment, and smoking had been taken into account, different
results in terms of quality of life may have been observed.
Conclusion
Buerger’s disease showed a more pronounced negative effect
on quality of life than ASO, particularly in terms of pain score.
However, when critical limb ischaemia was considered, both
ASO and Buerger’s disease impaired the quality of life in
patients to a similar degree. There is a need for further studies
to reassess the quality of life after psychological assessment and
treatment, where necessary, of patients.
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