Current trends in peripheral vascular surgery. When is surgical intervention the best option?

The peripheral artery questionnaire: a new disease-specific health status measure for patients with peripheral arterial disease

BACKGROUND

The most common indication for treating patients with peripheral arterial disease is to improve their health status: their symptoms, function, and quality of life. Quantifying health status requires a valid, reproducible, and sensitive disease-specific measure. The Peripheral Artery Questionnaire (PAQ) is a 20-item questionnaire developed to meet this need by quantifying patients' physical limitations, symptoms, social function, treatment satisfaction, and quality of life.

METHODS

Psychometric and clinical properties of the PAQ were evaluated in a prospective cohort study of 44 patients undergoing elective percutaneous peripheral revascularization. To establish reproducibility, 2 assessments were performed 2 weeks apart and before revascularization. The change in scores before and 6 weeks after revascularization were used to determine the instruments' responsiveness and were compared with the Short Form-36 and the Walking Impairment Questionnaire. A series of cross-sectional analyses were performed to establish the construct validity of the PAQ.

RESULTS

The 7 domains of the PAQ were internally reliable, with Cronbach alpha = 0.80 to 0.94. The test-retest reliability analyses revealed insignificant mean changes of 0.6 to 2.3 points (P = not significant for all). Conversely, the change after revascularization ranged from 13.7 to 41.9 points (P < or =.001 for all), reflecting substantial sensitivity of the PAQ to clinical improvement. The PAQ Summary Scale was the most sensitive of all scales tested. Construct validity was established by demonstrating correlations with other measures of patient health status.

CONCLUSIONS

The PAQ is a valid, reliable, and responsive disease-specific measure for patients with peripheral arterial disease. It may prove to be a useful end point in clinical trials and a potential aid in disease management.

Abdominal aortic aneurysm: an illustrated narrative review

OBJECTIVE

To present a descriptive review of abdominal aortic aneurysm (AAA), including a review of risk factors for and case finding in AAA for chiropractors as primary contact health care practitioners.

DATA SOURCES

Clinical and scientific literature identified through various sources including MEDLINE and citation tracking.

DATA SYNTHESIS

Selective narrative review of relevant literature.

RESULTS

AAA may be asymptomatic; however, back pain is a common presenting feature. Risk factors include male gender, increasing age, cigarette smoking, hypertension, chronic obstructive airway disease, claudication, and AAA in a first-degree relative. AAA should be considered in the differential diagnosis of older white patients, especially males, with low back pain. Estimated prevalence for AAAs in older males is in the order of 3% to 5%; rupture accounts for 1.7% of deaths in men aged 65 to 75 years. Elective surgical resection of AAAs (prior to rupture) offers a low operative mortality and good prognosis.

CONCLUSION

AAA should be considered in the differential diagnosis of older patients presenting with low back pain and those with risk factors for AAA. Chiropractors, as primary contact health care practitioners, have a responsibility to refer patients suspected of having AAA for appropriate imaging and, where indicated, vascular surgical opinion.