Letter to the Editor
We read with interest the recent article entitled ‘‘Clinical
endpoints in peripheral endovascular revascularisation
trials: a case for standardized definitions’’.1We agree that
there is a need to standardize outcome assessments but
believe that the authors’ have given insufficient impor-
tance to health-related quality of life tools. Patients with
intermittent claudication are the most common group to
receive peripheral endovascular revascularisation at many
centres, despite the current lack of clear evidence to show
this approach is more beneficial than conservative treat-
ment options that include exercise prescription.2,3The
primary reason to treat individuals with this problem is to
improve their health-related quality of life, since the risk of
limb loss is low. Treadmill walking and haemodynamic tests
provide objective assessment of walking impairment but do
not assess the effect that such limitations have on an
individual patient’s life style, as discussed in detail in
a previous editorial.4Intermittent claudication specific
health-related quality of life tools, such as the intermittent
claudication questionnaire5have been developed and we
believe should be included (along with treadmill and hae-
modynamic testing) in uniform reporting guidelines such as
this recent report. The authors’ mention the use of the
EQ5D and the walking impairment questionnaire (WIQ) in
baseline assessment only and not as outcome measures.
EQED is a generic health-related quality of life tool and we
would be interested in the reasoning for selecting this
instead of the SF-36, which is preferred by many investi-
gators,6as it covers a wider range of health domains.6The
WIQ is not normally considered a quality of life tool since
the questions relate specifically to walking distances and
not their effects on health-related quality of life.5We
support further assessment of the value of endovascular
therapy in randomised trials and encourage the inclusion of
appropriate health-related quality of life tools as outcome
1 Diehm N, Pattynama PM, Jaff MR, Cremonesi A, Becker GJ,
Hopkins LN, et al. Clinical endpoints in peripheral endovascular
revascularization trials: a case for standardized definitions. Eur
J Vasc Endovasc Surg 2008;36:409e19.
2 Spronk S, Bosch JL, den Hoed PT, Veen HF, Pattynama PM, Hunink
compared to supervised hospital-based exercise training in
patients with intermittent claudication: A randomized controlled
trial. J Vasc Surg, in press.
3 Whyman MR, Fowkes FG, Kerracher EM, Gillespie IN, Lee AJ,
Housley E, et al. Is intermittent claudication improved by
percutaneous transluminal angioplasty? A randomized controlled
trial. J Vasc Surg 1997;26:551e7.
4 Golledge J, Askew C, Leicht A, Oldenburg B. Outcome assess-
ment for intermittent claudication. Eur J Vasc Endovasc Surg
5 Chong PF, Garratt AM, Golledge J, Greenhalgh RM, Davies AH.
The intermittent claudication questionnaire: a patient-assessed
condition-specific health outcome measure. J Vasc Surg 2002;36:
6 Beattie DK, Golledge J, Greenhalgh RM, Davies AH. Quality of life
assessment in vascular disease: towards a consensus. Eur J Vasc
Endovasc Surg 1997;13:9e13.
The Vascular Biology Unit,
School of Medicine and Dentistry,
James Cook University,
Townsville, Queensland 4811, Australia
*Corresponding author. Tel.: þ61 7 4781 4730;
fax: þ61 7 4796 1401.
E-mail address: firstname.lastname@example.org
Available online 12 February 2009
ª 2008 European Society for Vascular Surgery. Published by Elsevier
Ltd. All rights reserved.
Response to Letter to Editor
The purpose of DEFINE group’s initiative was to arrive at
a broad-based consensus for baseline and end-point
DOI of original article: 10.1016/j.ejvs.2008.06.020.DOI of original article: 10.1016/j.ejvs.2008.11.040.
Eur J Vasc Endovasc Surg (2009) 37, 497e499