Abstract

NUNES, Sara  and  GOUVEIA, Carla. At the end, amputation was not needed!: A case report. Rev Port Med Geral Fam [online]. 2018, vol.34, n.5, pp.307-311. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v34i5.11834.

Introduction: We present a case report on peripheral arterial disease, in which we highlight the relevance of the role of the family doctor in various moments: management of modifiable risk factors, coordination of the primary care team, and longitudinal evaluation of the patient which, in turn, may be crucial for the diagnosis, prognosis and therapeutic choice, by providing relevant information to secondary care. Case description: An 82- year old woman with dyslipidemia, hypertension and type 2 diabetes, oriented and independent in her daily life activities, developed difficult-to-heal arterial ulcers which became infected. In the context of sepsis, a change in the mental status was detected and the diagnosis of dementia was assumed. Amputation was proposed in the presence of extensive bilateral peripheral arterial insufficiency of the lower limbs. This option was refused by the family and the patient was discharged to a nursing home. Infection control resulted in the recovery of the previous mental status. The patient was reassessed and a successful revascularization was performed. The ulcers healed completely, with recovery of the previous levels of autonomy and quality of life. Evaluating retrospectively the management of vascular risk factors, missed optimization opportunities were detected. For several months, continued nursing care was not adequately coordinated with medical observations, neither in primary nor in secondary care. The diagnosis of dementia during sepsis did not take in account information from the patient’s family, or of her family physician, on her previous mental status. Comment: This case report shows a good ending (maintenance of autonomy and quality of life), stressing the importance of controlling the risk factors for peripheral arterial disease, of the articulation between various health care professionals (between doctors and nurses, and between doctors in primary and secondary care), and the implications of an adequate differential diagnosis of altered mental status in the patient’s prognosis.

Keywords : Ischemia; Quality of life; Dementia; Amputation; Case report.

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