Case Archive
 
Vascular Surgery
Ref. # 96228

A 39 year old diabetic Michigan woman presented to the ER with pain from the hips to the feet, which were cool and bluish. Diagnosis was acute paresthesia in the bilateral lower extremities and phlebitis of the right leg, with sepsis ruled out. During the six days after discharge a primary care physician consulted the woman twice over the phone and prescribed pain medication. Due to mottled bilateral lower extremities, the woman went to the ER of another hospital, where she underwent bilateral embolectomies. A subsequent right femoral popliteal distal thrombo-embolectomy was unsuccessful. The patient required an above-the-knee amputation of the right leg. A medQuest vascular surgeon opined the attending doctors at the first hospital negligently failed to diagnose the patient's thrombus. The delay in appropriate care led to the amputation.

Vascular Surgery
Ref. # 38138

A 53 year old Connecticut man with prior medical history of hypertension and angioplasty was diagnosed with bilateral carotid artery stenosis. A left carotid endarterectomy was performed without complications. The patient had high-grade (80%-90%) stenosis on the right side; a right carotid endarterectomy was performed three months later. In recovery the patient developed transient ischemic attack with left facial weakness and was treated with Lasix and Decadron. The next day a positive Babinsky on the left side was noted and concurrent with right mid-cerebral arterial infarction. Three days later the patient had no cerebral activity and was allowed to expire. A medQuest vascular surgeon found clear deviations in post-operative care after the right carotid endarterectomy. Although the patient developed a deficit, there was a failure to determine whether the carotid was patent. Occlusion was not considered, as it should have been. A carotid was as it should have been. A carotid duplex or arteriogram were required. If either were positive for occlusion, then timely corrective surgery would have prevented the patient's demise. Furthermore, the family maintained they were advised that the patient's stenosis on the right side was less severe.

Vascular Surgery
Ref. # 26458

A 79 year old Michigan man underwent elective repair of an abdominal aortic aneurysm with aortobifemoral bypass reconstruction via retroperiontoneal approach. About ten days later he required an exploratory laparotomy which revealed a lacerated distal ileum with fistula. He returned to the O.R. four days later for removal of the infected graft. Subsequent surgeries were required in the following months, including an above-knee amputation due to necrosis. The attorney questioned the use of a surgical instrument, invented by the surgeon who performed the reconstruction. A medQuest vascular surgeon reported that the type of instrument was irrelevant, however it was below standard of care to perforate the bowel and not notice it. Timely diagnosis and repair would have led to a better outcome.




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