Non-operative Treatment of Advanced Limb Ischaemia: the Decision for Palliative Care

AbstractObjectives: 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