An elderly patient with severe peripheral vascular disease
Evenboer, J.; Wille, J.; van Asselt, K.M.
Nederlands Tijdschrift Voor Geneeskunde 163
2019
ISSN/ISBN: 1876-8784 PMID: 30730689 Document Number: 699532
Peripheral arterial disease is a common condition in elderly patients. Cases of severe peripheral vascular disease can be treated with endovascular revascularization or bypass surgery. An amputation may be necessary if revascularization treatments fail. A 94-year-old woman with dementia, living in a nursing home, was referred to the vascular surgery team for a painful ulcer on the left foot. Revascularization fails and due to the infectious status, an above-the-knee amputation seems necessary. Family and physicians, however, opt for a conservative, palliative policy and in the next few weeks the infectious ulcer develops into mummification. The patient nonetheless experiences a good quality of life until she becomes bedridden because of pneumonia. She dies 11 months after she was diagnosed with critical limb ischaemia. Adopting a conservative approach in elderly patients with severe peripheral arterial disease and dementia is a worthwhile alternative to amputation, and can achieve a reasonably good quality of life. Diaries maintained by family members can provide insight into the patient's quality of life.