Left in “no man’s land”: Narratives of patients and their significant others when revascularisation for chronic limb-threatening ischemia is no longer an option

Introduction Living with chronic limb-threatening ischemia (CLTI) disrupts individuals’ physical, emotional and social well-being. In response to the complexity of CLTI and the diverse needs of those affected, calls for multidisciplinary and person-centred care have intensified in recent years. Yet, limited research has explored the perspectives of individuals and their significant others on living with this condition. Objectives To explore and elaborate on the patterns that define the experiences of individuals living with CLTI and their significant others when revascularisation is no longer an option. Methods This qualitative study employed reflexive thematic analysis of semi-structured interviews with men and women with CLTI who were no longer eligible for limb-salvage revascularisation, and their significant others. Participants were recruited from vascular surgical and wound-care settings in Denmark. Between November 2023 and September 2024, twelve individuals were interviewed: ten together with a significant other and two individually. Findings Individuals were continually forced to adapt and redefine what constituted a meaningful life. We developed three main themes: l) Living with CLTI; a journey of battles in every part of my life , reflecting an ongoing negotiation between maintaining bodily integrity and coping with the realities of the disease, limited involvement in decisions and the role of significant others as combat allies; II) This is my life, and I will handle it to the best of my ability , emphasising how individuals were constantly up against time to comprehend their situation and make decisions amid the rapid disease progression coped through metaphors and humour; and III) My journey is carried by a dream of a good life, with or without the limb , reflecting the need for support to navigate their journey with resilience and hope. Across themes, we constructed an analytic narrative of powerlessness, hopelessness and a sense of being discarded from treatment, giving rise to the experience of being left in “ no man’s land ”. Conclusion CLTI profoundly affects the everyday lives of individuals and their significant others. Person-centred care that promotes timely and inclusive decision-making is essential to alleviate the disease burden and support individuals in achieving a meaningful life.