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Non-operative treatment of advanced limb ischaemia: the decision for palliative care
W B Campbell1, P Verfaillie, B M Ridler
1Department of Surgery, Royal Devon and Exeter Hospital, Exeter, EX2 5DW, UK.
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.