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

Objectives: to identify and describe patients with advanced limb ischemia w ho were selected for palliative care, rather than surgical intervention. Design: case-note review of patients identified from a prospective I regist er. Materials and methods: thirty patients (22 female; median age 87 years) wer e identified during 1993-1998, for whom a clearly documented decision was m ade for palliative care, rather than major amputation ol possible revascula risation. Results: two-thirds of the patients had limiting cardiac problems, two-thir ds were immobile, and 47% had suffered a stroke. Half had three or move imp ortant co-morbidities, Twelve (40%) had unsalvageable acute ischaemia. Ther e 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 hour to 42 das (median 3.5 days). Conclusion: there is a small subgroup of patients with advanced ischaemia w ho are best treated palliatively, and who have not been well described befo re. Recognising these patients, recording discussions about their managemen t, and a high standard of terminal care are all important.