Functional status and quality of life after treatment of peripheral arterial disease

In this thesis, different aspects have been explored on the treatment and patient-reported outcomes(PROMs) of patients with different stages of peripheral arterial disease (PAD). The first part of this thesis focuses on treatment and PROMs in patients with Intermittent Claudication (IC); the second part is about PROMs after treatment in patients with Critical Limb Ischemia (CLI). In patients with IC we confirmed the reliability and validity of two PROMs, the Dutch version of the Vascular Quality of Life questionnaire (VascuQol, measuring quality of life(Qol)) and the Academic Medical Center Linear Disability Score (ALDS, measuring functional status (FS)). Furthermore, we found that instruments that take into account the perceived impairment, might better guide and evaluate treatment decisions than patients’ estimated walking distances or on a treadmill. A systematic review of studies regarding the relative effectiveness of Percutaneous Transluminal Angioplasty (PTA), (supervised) exercise therapy (S)ET or their combination for patients with IC concluded that in general the effectiveness of PTA and (S)ET was equivalent. As the benefit of SET was unclear in specifically patients with IC and an iliac artery obstruction, we presented the design of a multicenter randomised controlled trial including these patients randomly assigned to PTA or SET. Regarding patients with CLI we found that the ALDS it is a valuable and sophisticated instrument to measure changes in functional status in these patients. Finally, the last chapter introduced a novel method, the minimally important difference (MID) to better express the proportion of patients who clinically benefitted or deteriorated after treatment of CLI.