Non-operative treatment of advanced limb ischaemia: the decision for palliative care.
OBJECTIVE
to identify and describe patients with advanced limb ischaemia who were selected for palliative care, rather than surgical intervention.


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


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).


CONCLUSIONS
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.
Campbell
W B
WB
Department of Surgery, Royal Devon and Exeter Hospital, Exeter, EX2 5DW, UK.
Verfaillie
P
P
Ridler
B M
BM
Thompson
J F
JF
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000075202:Contraindications; D003657:Decision Making; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D007103:Immobilization; D007511:Ischemia / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010358:Patient Participation; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D011446:Prospective Studies; D012017:Referral and Consultation; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications; D015996:Survival Rate; D013727:Terminal Care; D014656:Vascular Surgical Procedures
D000701:Analgesics, Opioid