Non-operative treatment of advanced limb ischaemia: the decision for palliative care

Eur J Vasc Endovasc Surg. 2000 Mar;19(3):246-9. doi: 10.1053/ejvs.1999.1052.

Abstract

Objectives: to identify and describe patients with advanced limb ischaemia who were selected for palliative care, rather than surgical intervention.

Design: case-note review of patients identified from a prospective register.

Materials and methods: thirty patients (22 female; median age 87 years) were identified during 1993-1998, for whom a clearly documented decision was made for palliative care, rather than major amputation or possible revascularisation.

Results: two-thirds of the patients had limiting cardiac problems, two-thirds were immobile, and 47% had suffered a stroke. Half had three or more important co-morbidities. Twelve (40%) had unsalvageable acute ischaemia. There were clear records of the decision about non-intervention being made by a consultant in 87%; being discussed with the patient in 43%; and with known relatives in 90%. Survival after this decision ranged from <24 hours to 42 days (median 3.5 days).

Conclusion: there is a small subgroup of patients with advanced ischaemia who are best treated palliatively, and who have not been well described before. Recognising these patients, recording discussions about their management, and a high standard of terminal care are all important.

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Amputation
  • Analgesics, Opioid / therapeutic use
  • Contraindications
  • Decision Making
  • Female
  • Heart Diseases / complications
  • Humans
  • Immobilization
  • Ischemia / therapy*
  • Leg / blood supply*
  • Male
  • Middle Aged
  • Palliative Care*
  • Patient Participation
  • Physician-Patient Relations
  • Professional-Family Relations
  • Prospective Studies
  • Referral and Consultation
  • Registries
  • Retrospective Studies
  • Stroke / complications
  • Survival Rate
  • Terminal Care
  • Vascular Surgical Procedures

Substances

  • Analgesics, Opioid