“True patient-centred care demands more than interpreting scans and assessing flow.” This is according to Launch Pad columnist Adam Talbot (Manchester, UK), who here argues that vascular surgeons must broaden their definition of limb function beyond the realm of mechanics when it comes to the management of patients with chronic limb-threatening ischaemia (CLTI).
In vascular surgery, we are trained to act decisively to save the leg. For patients with CLTI, the rationale for revascularisation is often framed around preserving ambulation and independence. Yet when a limb is perceived as non-functional, for example due to neurological impairment or immobility, decisions about intervention can shift. Amputation may be viewed as the pragmatic or inevitable choice.
However, such reasoning risks reducing the limb to nothing more than a mechanical structure, valued only for its ability to enable walking. In doing so, we overlook what a limb often represents to patients: a source of stability, a tool for transfers, and a contributor to cardiovascular health. Beyond physical roles, limbs also carry deep psychological and symbolic meaning, tied to body image, identity, and dignity. A limb can remain profoundly meaningful even when its motor function is limited.
When decisions are made solely on the basis of perceived usefulness, we risk falling into the trap of ableist bias, assuming that a life without walking is inherently less valuable, or that limb preservation is not worthwhile. Such assumptions can unconsciously influence multidisciplinary team (MDT) discussions, particularly when the patient’s lived experience is not fully appreciated.
True patient-centred care demands more than interpreting scans and assessing flow. It requires seeing the person behind the limb: understanding how they use it, what it represents, and what matters most to them. Direct clinical engagement and involving patients in shared decisionmaking provides context that imaging and physiological data alone cannot. Clinicians who spend time with patients are often best placed to advocate for these broader considerations within the MDT.
We must also reflect on how our language shapes our decisions. Describing a limb as non-functional can prematurely close off treatment pathways, while framing it as functionally important in non-ambulatory ways keeps options open. Revascularisation should not be judged solely by its potential to restore walking. Instead, we must broaden our definition of function to include the ways a limb supports independence, self-esteem, and quality of life.
As vascular clinicians, our challenge is to look beyond perfusion and anatomy to the human meaning behind each decision. A limb is more than just function. It is part of the person who lives with it, and our care should reflect that truth.
Adam Talbot is a specialty trainee in vascular surgery based in Manchester, UK, and education representative for the Rouleaux Club—the vascular trainees’ association for Great Britain and Ireland.
