The Role of Palliative Care in the Management of Acute Lower Limb Ischaemia

Acute limb ischaemia (ALI) is a vascular emergency that often involves life-or-limb-threatening consequences. For patients with irreversible limb ischaemia or those who are high-risk surgical candidates, palliative care may be underutilised. This study examined the role and use of palliative care for ALI patients at our institution.

A retrospective observational study was conducted for ALI patients referred to the vascular service from January 2019 to December 2023. Data collected included demographics, comorbidities using the Charlson comorbidity index (CCI), the primary intervention offered and their Australia-modified Karnofsky Performance Status (AKPS). Outcomes included 30-day mortality, major limb amputation and referral to palliative care.

A total of 114 patients, with median age of 75, and 65 male patients were included. On presentation, 2 patients (1.8%) underwent major limb amputation and 15 patients (13.2%) received palliative care. Patients who received palliative care on presentation were, on average, older by 11.4 years, had a higher CCI score by 2.7 and a lower AKPS by 19.1 (p < 0.01) compared to patients who did not receive palliative care. Within 30 days, 12 (80%) of the primary palliation group died, compared to 8 (8.1%) in the non-palliation group. None of the patients who underwent amputation received palliative care or died within 30 days.

ALI is associated with high mortality. In selected patients, particularly those with non-viable limbs, advanced age, high comorbidity burden and low functional status, early palliative care may be more appropriate than surgery. Avoiding 'palliative amputation' through timely palliative care involvement offers a more holistic, patient-centred approach to care at the end of life.