Rethinking advance care planning in chronic limb-threatening ischemia: A narrative review of the literature

<h2>Abstract:</h2><h3>Objective</h3> Although patients with chronic limb threatening ischemia (CLTI) who undergo major amputation experience elevated one-year mortality risks, data on advanced care planning in this population is limited. The aim of this review was to summarize the current and evidence-based implementation of advanced care planning (ACP) among patients with CLTI. <h3>Methods</h3> A literature review of advanced care planning among patients with CLTI was performed. The Pubmed and Google Scholar databases were queried for articles on frequency, quality, and outcomes of ACP for patients with CLTI. <h3>Results</h3> Among patients who undergo major amputation for CLTI, reported mortality is 30-50% at 1-year follow up. Reported ACP completion rates prior to surgical intervention for patients with CLTI ranged from 5-30%. Palliative care utilization was limited, with only 1-3% of patients with CLTI receiving palliative care referrals prior to surgery, and <30% of patients receiving palliative care consultations prior to death. Advance directives (AD) for patients with CLTI were similarly lacking, with 14-30% of vascular patients completing AD prior to death. <h3>Conclusions</h3> While advance care planning (ACP) has been shown to enhance quality of life for both patients and caregivers and reduce healthcare costs in similar populations, ACP remains underutilized and poorly characterized in the vascular patient population. Further research is needed to evaluate ACP implementation for patients with CLTI and other life-limiting vascular pathologies.