Depression is associated with worse patency and recurrent leg symptoms after lower extremity revascularization

Objectives Depression is associated with worse outcomes after coronary artery bypass surgery, but its association with the results after revascularization for symptomatic peripheral arterial disease (PAD) is unknown. This study assessed the association between depression and patency, recurrent sympt...

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Veröffentlicht in:Journal of vascular surgery 2007-04, Vol.45 (4), p.744-750
Hauptverfasser: Cherr, Gregory S., MD, Wang, Jiping, MD, PhD, Zimmerman, Pamela M., MD, Dosluoglu, Hasan H., MD
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container_end_page 750
container_issue 4
container_start_page 744
container_title Journal of vascular surgery
container_volume 45
creator Cherr, Gregory S., MD
Wang, Jiping, MD, PhD
Zimmerman, Pamela M., MD
Dosluoglu, Hasan H., MD
description Objectives Depression is associated with worse outcomes after coronary artery bypass surgery, but its association with the results after revascularization for symptomatic peripheral arterial disease (PAD) is unknown. This study assessed the association between depression and patency, recurrent symptoms, and limb salvage after revascularization for symptomatic PAD. Methods Electronic medical records were retrospectively reviewed for all patients with symptomatic PAD who underwent intervention (open, endovascular, or combined) between January 2000 and October 2004. All patients were previously screened for depression, and treatment was initiated as indicated by the primary care physician or psychiatrist. Demographic data and outcomes were recorded using published guidelines. Outcomes of interest included primary patency of the revascularization (bypass graft or angioplasty/stented artery), assisted primary patency, secondary patency, recurrent symptomatic ipsilateral PAD, and major amputation. Follow-up was available for all patients (mean, 23.4 ± 14.1 months). Results Board-certified vascular surgeons performed all interventions. At the time of intervention, 78 (36.1%) of 216 patients had been diagnosed with depression. Compared with those without depression, depressed patients were younger (64.4 vs 69.1 years; P = .001), currently using tobacco (74.4% vs 51.4%; P = .001), and less likely to have hypertension (79.5% vs 89.9%; P = .03). No other significant differences were noted for cardiovascular risk factors or prevalent comorbidities. During follow-up, 50 patients (23.1%) had failing or failed revascularizations, and 24 (11%) had amputations. Those with depression at the time of the PAD intervention, compared at 24 months with patients without depression, had significantly worse primary patency (58.2% vs 79.8%; P = .02), primary assisted patency (59.5% vs 81.5%; P = .01), and secondary patency (60.2% vs 82.2%; P = .007). They also had a significantly increased risk of recurrent symptomatic PAD (33.7% vs 20.8%; P = .03) but not major amputation (13.8% vs 10.4%; P = .73). By multivariate analysis, patients with depression were at significantly increased risk for recurrent symptomatic PAD (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.03 to 3.02; P = .04) and failure of revascularization (HR, 2.18; 95% CI, 1.22 to 3.88; P < .01), but not major amputation. Conclusions Depression is common among patients undergoing intervention for symptomatic PAD.
doi_str_mv 10.1016/j.jvs.2006.11.057
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This study assessed the association between depression and patency, recurrent symptoms, and limb salvage after revascularization for symptomatic PAD. Methods Electronic medical records were retrospectively reviewed for all patients with symptomatic PAD who underwent intervention (open, endovascular, or combined) between January 2000 and October 2004. All patients were previously screened for depression, and treatment was initiated as indicated by the primary care physician or psychiatrist. Demographic data and outcomes were recorded using published guidelines. Outcomes of interest included primary patency of the revascularization (bypass graft or angioplasty/stented artery), assisted primary patency, secondary patency, recurrent symptomatic ipsilateral PAD, and major amputation. Follow-up was available for all patients (mean, 23.4 ± 14.1 months). Results Board-certified vascular surgeons performed all interventions. At the time of intervention, 78 (36.1%) of 216 patients had been diagnosed with depression. Compared with those without depression, depressed patients were younger (64.4 vs 69.1 years; P = .001), currently using tobacco (74.4% vs 51.4%; P = .001), and less likely to have hypertension (79.5% vs 89.9%; P = .03). No other significant differences were noted for cardiovascular risk factors or prevalent comorbidities. During follow-up, 50 patients (23.1%) had failing or failed revascularizations, and 24 (11%) had amputations. Those with depression at the time of the PAD intervention, compared at 24 months with patients without depression, had significantly worse primary patency (58.2% vs 79.8%; P = .02), primary assisted patency (59.5% vs 81.5%; P = .01), and secondary patency (60.2% vs 82.2%; P = .007). They also had a significantly increased risk of recurrent symptomatic PAD (33.7% vs 20.8%; P = .03) but not major amputation (13.8% vs 10.4%; P = .73). By multivariate analysis, patients with depression were at significantly increased risk for recurrent symptomatic PAD (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.03 to 3.02; P = .04) and failure of revascularization (HR, 2.18; 95% CI, 1.22 to 3.88; P &lt; .01), but not major amputation. Conclusions Depression is common among patients undergoing intervention for symptomatic PAD. After intervention, patients with depression have worse outcomes for the affected leg. Prospective analysis is required to confirm these results.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2006.11.057</identifier><identifier>PMID: 17303367</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Amputation - statistics &amp; numerical data ; Depression - epidemiology ; Depression - etiology ; Depression - physiopathology ; Female ; Follow-Up Studies ; Humans ; Limb Salvage - methods ; Limb Salvage - statistics &amp; numerical data ; Lower Extremity - blood supply ; Male ; Medical Records Systems, Computerized ; Middle Aged ; New York - epidemiology ; Peripheral Vascular Diseases - epidemiology ; Peripheral Vascular Diseases - physiopathology ; Peripheral Vascular Diseases - psychology ; Peripheral Vascular Diseases - surgery ; Prevalence ; Prognosis ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Risk Assessment ; Surgery ; Time Factors ; Treatment Outcome ; Vascular Patency ; Vascular Surgical Procedures - statistics &amp; numerical data</subject><ispartof>Journal of vascular surgery, 2007-04, Vol.45 (4), p.744-750</ispartof><rights>The Society for Vascular Surgery</rights><rights>2007 The Society for Vascular Surgery</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c449t-32d991bbeeba0dce135a5164aeaa786d737d571b6818783ed0efa367f83173ec3</citedby><cites>FETCH-LOGICAL-c449t-32d991bbeeba0dce135a5164aeaa786d737d571b6818783ed0efa367f83173ec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2006.11.057$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17303367$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cherr, Gregory S., MD</creatorcontrib><creatorcontrib>Wang, Jiping, MD, PhD</creatorcontrib><creatorcontrib>Zimmerman, Pamela M., MD</creatorcontrib><creatorcontrib>Dosluoglu, Hasan H., MD</creatorcontrib><title>Depression is associated with worse patency and recurrent leg symptoms after lower extremity revascularization</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Objectives Depression is associated with worse outcomes after coronary artery bypass surgery, but its association with the results after revascularization for symptomatic peripheral arterial disease (PAD) is unknown. This study assessed the association between depression and patency, recurrent symptoms, and limb salvage after revascularization for symptomatic PAD. Methods Electronic medical records were retrospectively reviewed for all patients with symptomatic PAD who underwent intervention (open, endovascular, or combined) between January 2000 and October 2004. All patients were previously screened for depression, and treatment was initiated as indicated by the primary care physician or psychiatrist. Demographic data and outcomes were recorded using published guidelines. Outcomes of interest included primary patency of the revascularization (bypass graft or angioplasty/stented artery), assisted primary patency, secondary patency, recurrent symptomatic ipsilateral PAD, and major amputation. Follow-up was available for all patients (mean, 23.4 ± 14.1 months). Results Board-certified vascular surgeons performed all interventions. At the time of intervention, 78 (36.1%) of 216 patients had been diagnosed with depression. Compared with those without depression, depressed patients were younger (64.4 vs 69.1 years; P = .001), currently using tobacco (74.4% vs 51.4%; P = .001), and less likely to have hypertension (79.5% vs 89.9%; P = .03). No other significant differences were noted for cardiovascular risk factors or prevalent comorbidities. During follow-up, 50 patients (23.1%) had failing or failed revascularizations, and 24 (11%) had amputations. Those with depression at the time of the PAD intervention, compared at 24 months with patients without depression, had significantly worse primary patency (58.2% vs 79.8%; P = .02), primary assisted patency (59.5% vs 81.5%; P = .01), and secondary patency (60.2% vs 82.2%; P = .007). They also had a significantly increased risk of recurrent symptomatic PAD (33.7% vs 20.8%; P = .03) but not major amputation (13.8% vs 10.4%; P = .73). By multivariate analysis, patients with depression were at significantly increased risk for recurrent symptomatic PAD (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.03 to 3.02; P = .04) and failure of revascularization (HR, 2.18; 95% CI, 1.22 to 3.88; P &lt; .01), but not major amputation. Conclusions Depression is common among patients undergoing intervention for symptomatic PAD. After intervention, patients with depression have worse outcomes for the affected leg. Prospective analysis is required to confirm these results.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amputation - statistics &amp; numerical data</subject><subject>Depression - epidemiology</subject><subject>Depression - etiology</subject><subject>Depression - physiopathology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Limb Salvage - methods</subject><subject>Limb Salvage - statistics &amp; numerical data</subject><subject>Lower Extremity - blood supply</subject><subject>Male</subject><subject>Medical Records Systems, Computerized</subject><subject>Middle Aged</subject><subject>New York - epidemiology</subject><subject>Peripheral Vascular Diseases - epidemiology</subject><subject>Peripheral Vascular Diseases - physiopathology</subject><subject>Peripheral Vascular Diseases - psychology</subject><subject>Peripheral Vascular Diseases - surgery</subject><subject>Prevalence</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular Patency</subject><subject>Vascular Surgical Procedures - statistics &amp; numerical data</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUGr1DAUhYsovnlPf4Abycpda27TNi2CIE99Cg9cqOuQJrea2jZjbjpj_fVmmAHBhZtcCOecy_lulj0DXgCH5uVYjAcqSs6bAqDgtXyQ7YB3Mm9a3j3MdlxWkNclVFfZNdHIOUDdysfZFUjBhWjkLlve4j4gkfMLc8Q0kTdOR7Ts6OJ3dvSBkO3Tx2I2phfLApo1BFwim_Abo23eRz8n4xAxsMkf04u_YsDZxS2JD5rMOungfuuYdjzJHg16Inx6mTfZ1_fvvtx-yO8_3X28fXOfm6rqYi5K23XQ94i95tYgiFrX0FQatZZtY6WQtpbQNy20shVoOQ469RlakaqhETfZi3PuPvifK1JUsyOD06QX9Cspmeq3ZdcmIZyFJniigIPaBzfrsCng6gRZjSpBVifICkAlyMnz_BK-9jPav44L1SR4dRZgqnhwGBQZlwiidQlfVNa7_8a__sdtJrc4o6cfuCGNfg1LYqdAUam4-ny68unIvOFlKTgXfwDPEaUx</recordid><startdate>20070401</startdate><enddate>20070401</enddate><creator>Cherr, Gregory S., MD</creator><creator>Wang, Jiping, MD, PhD</creator><creator>Zimmerman, Pamela M., MD</creator><creator>Dosluoglu, Hasan H., MD</creator><general>Mosby, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20070401</creationdate><title>Depression is associated with worse patency and recurrent leg symptoms after lower extremity revascularization</title><author>Cherr, Gregory S., MD ; Wang, Jiping, MD, PhD ; Zimmerman, Pamela M., MD ; Dosluoglu, Hasan H., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c449t-32d991bbeeba0dce135a5164aeaa786d737d571b6818783ed0efa367f83173ec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amputation - statistics &amp; numerical data</topic><topic>Depression - epidemiology</topic><topic>Depression - etiology</topic><topic>Depression - physiopathology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Limb Salvage - methods</topic><topic>Limb Salvage - statistics &amp; numerical data</topic><topic>Lower Extremity - blood supply</topic><topic>Male</topic><topic>Medical Records Systems, Computerized</topic><topic>Middle Aged</topic><topic>New York - epidemiology</topic><topic>Peripheral Vascular Diseases - epidemiology</topic><topic>Peripheral Vascular Diseases - physiopathology</topic><topic>Peripheral Vascular Diseases - psychology</topic><topic>Peripheral Vascular Diseases - surgery</topic><topic>Prevalence</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular Patency</topic><topic>Vascular Surgical Procedures - statistics &amp; numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cherr, Gregory S., MD</creatorcontrib><creatorcontrib>Wang, Jiping, MD, PhD</creatorcontrib><creatorcontrib>Zimmerman, Pamela M., MD</creatorcontrib><creatorcontrib>Dosluoglu, Hasan H., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cherr, Gregory S., MD</au><au>Wang, Jiping, MD, PhD</au><au>Zimmerman, Pamela M., MD</au><au>Dosluoglu, Hasan H., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Depression is associated with worse patency and recurrent leg symptoms after lower extremity revascularization</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2007-04-01</date><risdate>2007</risdate><volume>45</volume><issue>4</issue><spage>744</spage><epage>750</epage><pages>744-750</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Objectives Depression is associated with worse outcomes after coronary artery bypass surgery, but its association with the results after revascularization for symptomatic peripheral arterial disease (PAD) is unknown. This study assessed the association between depression and patency, recurrent symptoms, and limb salvage after revascularization for symptomatic PAD. Methods Electronic medical records were retrospectively reviewed for all patients with symptomatic PAD who underwent intervention (open, endovascular, or combined) between January 2000 and October 2004. All patients were previously screened for depression, and treatment was initiated as indicated by the primary care physician or psychiatrist. Demographic data and outcomes were recorded using published guidelines. Outcomes of interest included primary patency of the revascularization (bypass graft or angioplasty/stented artery), assisted primary patency, secondary patency, recurrent symptomatic ipsilateral PAD, and major amputation. Follow-up was available for all patients (mean, 23.4 ± 14.1 months). Results Board-certified vascular surgeons performed all interventions. At the time of intervention, 78 (36.1%) of 216 patients had been diagnosed with depression. Compared with those without depression, depressed patients were younger (64.4 vs 69.1 years; P = .001), currently using tobacco (74.4% vs 51.4%; P = .001), and less likely to have hypertension (79.5% vs 89.9%; P = .03). No other significant differences were noted for cardiovascular risk factors or prevalent comorbidities. During follow-up, 50 patients (23.1%) had failing or failed revascularizations, and 24 (11%) had amputations. Those with depression at the time of the PAD intervention, compared at 24 months with patients without depression, had significantly worse primary patency (58.2% vs 79.8%; P = .02), primary assisted patency (59.5% vs 81.5%; P = .01), and secondary patency (60.2% vs 82.2%; P = .007). They also had a significantly increased risk of recurrent symptomatic PAD (33.7% vs 20.8%; P = .03) but not major amputation (13.8% vs 10.4%; P = .73). By multivariate analysis, patients with depression were at significantly increased risk for recurrent symptomatic PAD (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.03 to 3.02; P = .04) and failure of revascularization (HR, 2.18; 95% CI, 1.22 to 3.88; P &lt; .01), but not major amputation. Conclusions Depression is common among patients undergoing intervention for symptomatic PAD. After intervention, patients with depression have worse outcomes for the affected leg. Prospective analysis is required to confirm these results.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>17303367</pmid><doi>10.1016/j.jvs.2006.11.057</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Amputation - statistics & numerical data
Depression - epidemiology
Depression - etiology
Depression - physiopathology
Female
Follow-Up Studies
Humans
Limb Salvage - methods
Limb Salvage - statistics & numerical data
Lower Extremity - blood supply
Male
Medical Records Systems, Computerized
Middle Aged
New York - epidemiology
Peripheral Vascular Diseases - epidemiology
Peripheral Vascular Diseases - physiopathology
Peripheral Vascular Diseases - psychology
Peripheral Vascular Diseases - surgery
Prevalence
Prognosis
Proportional Hazards Models
Recurrence
Retrospective Studies
Risk Assessment
Surgery
Time Factors
Treatment Outcome
Vascular Patency
Vascular Surgical Procedures - statistics & numerical data
title Depression is associated with worse patency and recurrent leg symptoms after lower extremity revascularization
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