End of life and palliative care for patients with peripheral arterial disease: a systematic review and survey of vascular specialists’ perceptions of prognosis and death

A key finding of a recent major academic commission on the value of death was the need for society to reconsider death and dying. 1 In developed healthcare systems, overtreatment and a lack of recognition of end stage disease were an important finding, as was the need for more considered palliative care. Several conditions treated by vascular specialists have high chronic disability and mortality rates, 2 but there is little academic discussion around palliation. This may seem obvious in an acute setting, such as for ruptured aneurysms, but is less clear when managing long term conditions such as chronic limb threatening ischaemia (CLTI). At the moment, even vascular specialists’ perception of prognosis for higher risk conditions is not clearly defined. The aims of this study were to systematically review the published literature on vascular specialists’ perceptions of prognosis for patients with peripheral arterial disease (PAD), then to assess (via questionnaire) their contemporary perceptions of prognosis, death, and use of palliative care specifically for CLTI as the area of PAD with the highest morbidity and mortality.