Open AccessImpact of a lifestyle clinic on vascular workload: analysis of factors predicting a successful outcome
Author(s) -
Olojugba D. H.,
Vallabhaneni R.,
McCormick S.,
Reilly D. T.,
Blair S. D.,
Greaney M. G.
Publication year - 2000
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.2000.01420-63.x
Subject(s) - medicine , intermittent claudication , claudication , logistic regression , physical therapy , workload , radiological weapon , ankle , revascularization , surgery , arterial disease , vascular disease , myocardial infarction , computer science , operating system
Background: Regular exercise and risk factor control has been shown to treat patients with intermittent claudication effectively; however, patients are often non‐compliant and never achieve the full benefits of a conservative approach. In this vascular unit, a nurse‐led lifestyle intervention clinic has been established with the aim of optimizing the conservative management of such patients. The aim of this study was to assess the short‐term impact of this strategy on radiological and operative vascular workload since its introduction in 1997, and to identify factors predictive of a successful conservative outcome. Methods: The number of operative and radiological lower limb interventional procedures performed between January 1996 and January 1999 was obtained from departmental databases. The details of 145 consecutive referrals to the claudication clinic were also retrieved. These details were entered into a separate database for analysis. The factors analysed included age, sex, duration of symptoms, ankle: brachial pressure index and maximal walking distance at the start of the programme, co‐morbid problems, smoking history and attendance. The outcome was change in claudication distance after 3 months of therapy. Analysis was performed using logistic and multiple linear regression models. Results: Open revascularization procedures reduced from 104 in 1996 to 52 in 1998, femoral‐to‐popliteal bypass procedures reduced from 66 to 18. Iliac and lower limb angioplasties reduced from 133 to 101, and there were 53 major lower limb amputations in 1996 compared with 58 in 1998. The lifestyle clinic achieved a 36 per cent smoking cessation rate. Change in claudication distance ranged from −51 to 3100 (median 126) per cent. None of the factors analysed could significantly predict a successful outcome. Conclusion: Lifestyle management is an effective strategy in management of claudicants. It can also reduce interventional vascular workload. The prediction of a successful outcome in individual patients may not be possible. © 2000 British Journal of Surgery Society Ltd