Peters CML, de Vries J, Steunenberg SL, Ho GH, Lodder P, van der Laan L, et al.
Annals of vascular surgery. Date of publication 2019 Jul 1;volume 58():142-150.
1. Ann Vasc Surg. 2019 Jul;58:142-150. doi: 10.1016/j.avsg.2018.10.045. Epub 2019
Feb 4.
Is There an Important Role for Anxiety and Depression in the Elderly Patients
with Critical Limb Ischemia, Especially After Major Amputation?
Peters CML(1), de Vries J(2), Steunenberg SL(3), Ho GH(3), Lodder P(4), van der
Laan L(3).
Author information:
(1)Department of Surgery, Amphia Hospital, Breda, The Netherlands. Electronic
address: chloe.peters1990@gmail.com.
(2)Department of Medical and Clinical Psychology, Tilburg University, The
Netherlands; Department of Medical Psychology, Elisabeth Tweesteden Hospital,
Tilburg, The Netherlands.
(3)Department of Surgery, Amphia Hospital, Breda, The Netherlands.
(4)Department of Medical and Clinical Psychology, Tilburg University, The
Netherlands; Department of Methodology and Statistics, Tilburg University, The
Netherlands.
Comment in
Ann Vasc Surg. 2019 Jul;58:390.
BACKGROUND: In patients with critical limb ischemia, an association is assumed
between depression and worse outcome for morbidity, such as major limb
amputation. After major amputation, anxiety and depression are common. We aimed
to determine the association of depressive and anxiety symptoms in the elderly
with critical limb ischemia, especially after major limb amputation.
METHODS: Patients with critical limb ischemia aged ≥70 years were included in
this prospective observational cohort study between January 2012 and February
2016 in 2 Dutch hospitals. After a multidisciplinary vascular conference,
patients were divided into 4 treatment groups: endovascular revascularization,
surgical revascularization, conservative therapy, and primary major amputation.
In a 1-year follow-up period, depression and anxiety were measured 4 times using
the Dutch versions of the Center for Epidemiological Studies Depression Scale and
the State-Trait Anxiety Inventory.
RESULTS: One Hundred eighty-seven patients were included. Within 1 year, 44
patients underwent a major limb amputation. Lower amputation-free survival did
not differ significantly for patients with versus without greater anxiety (X2
[1] = 0.689, P = 0.407) and also not for patients with versus without more
depressive symptoms (X2 [1] = 0.614, P = 0.433). For both groups, there were no
significant changes in anxiety scores over time. After a median follow-up time of
336.5 days and 365 days, depressive symptoms significantly decreased in amputees,
respectively, 8.5 vs. 4.5 (95% CI 1.76-7.48, P = 0.002) and 8.5 vs. 4.3 (95% CI
0.61-9.82, P = 0.027) when compared to the baseline measurement. Similarly,
nonamputees had significantly lower overall score for depressive symptoms after a
median follow-up time of 365 days (10.1 vs. 4.1, 95% CI 4.49 to 6.90, P < 0.001).
CONCLUSIONS: In the opinion of the medical health care provider, amputation is a
severe and unwanted end phase of critical limb ischemia. However, depressive
symptoms seem to decrease over time and anxiety symptoms do not seem to be
affected in patients after major limb amputation. In addition, patients with
greater trait anxiety or more depressive symptoms at baseline did not have
significantly higher amputation rates. These findings are similar to the course
of depressive and anxiety symptoms for the elderly patients without major limb
amputation.
Copyright © 2019 Elsevier Inc. All rights reserved.
DOI: 10.1016/j.avsg.2018.10.045
PMID: 30731224 [Indexed for MEDLINE]
