Nederlands tijdschrift voor geneeskunde · 2019
[An elderly patient with severe peripheral vascular disease].
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Evenboer Januska, Wille Jan, van Asselt Kristel M
Аннотация
BACKGROUND: 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.
CASE DESCRIPTION: 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.
CONCLUSION: 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.
CASE DESCRIPTION: 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.
CONCLUSION: 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.