Vascular surgery clinical negligence reports
Independent reports from consultant vascular surgeons on limb ischaemia, DVT, compartment syndrome and amputation, prepared to CPR Part 35 for courts in England and Wales.
Many vascular negligence claims turn on timing, and in acute limb ischaemia a delay of hours can decide whether a limb is saved. Claims include an acutely ischaemic leg that was not recognised, an arterial injury missed after a fracture or during surgery, a deep vein thrombosis that was not prevented or diagnosed, and complications of aneurysm repair or varicose vein treatment. The outcome can be lasting damage to a limb, a pulmonary embolism or an amputation.
Expert Medical Examination arranges independent reports from GMC-registered consultant vascular surgeons, covering breach of duty where the vascular care is criticised, and causation, condition and prognosis where the harm is vascular.
Breach of duty in vascular care
The expert considers whether the assessment, investigations and timing of surgery met the standard of a reasonably competent vascular surgeon at the time, judged without hindsight. Under Bolam, care is not negligent if a responsible body of vascular surgeons would accept it as proper, and under Bolitho that opinion must have a logical basis.
Amputation and long-term outcome
Where the result was an amputation or lasting damage to a limb, the report sets out the current condition, the further surgery that may be needed and the long-term outlook, including post-thrombotic syndrome after a DVT. Rehabilitation and care needs may call for further experts.
Consent to planned vascular surgery
Many small aneurysms are monitored rather than repaired, and some varicose veins are managed without surgery. Where a claim says those options were never discussed, the expert can say whether they were reasonable alternatives at the time, which under McCulloch is judged by the professional practice test.
Instruct a vascular surgery expert
Send the allegations and the complete records, and we will match the claim to a consultant vascular surgeon whose practice covers the procedure or condition in question.
- Acute limb ischaemia missed or treated late
- Arterial injury after fractures, dislocations and surgery
- DVT and pulmonary embolism claims
- Compartment syndrome and delayed fasciotomy
- Amputation causation and avoidability
- Aneurysm surveillance and repair claims
- Varicose vein treatment complications
Vascular surgery clinical negligence reports: FAQs
Why does timing matter so much in a vascular negligence claim?
When an artery is blocked or damaged, the tissue it supplies is starved of oxygen, and the damage grows the longer the blood supply is lost. A delay in diagnosis or surgery can decide whether a limb is saved. The expert rebuilds the timeline from the observation charts, nursing notes, imaging and operation times, then gives an opinion on whether earlier treatment would, on the balance of probabilities, have changed the outcome.
Who comments on whether a DVT should have been prevented?
An expert from the specialty responsible for prevention, because breach of duty is judged against the standard of the specialty whose care is criticised. If thromboprophylaxis was not given after an orthopaedic operation, for example, an orthopaedic surgeon addresses breach. A vascular surgeon can then address causation, meaning whether prophylaxis would more likely than not have prevented the clot and whether earlier diagnosis would have changed the outcome, as well as long-term effects such as post-thrombotic syndrome.
What if earlier treatment would only have given a chance of saving the limb?
A lost chance is not enough on its own. Causation must be proved on the balance of probabilities, so the usual question is whether timely treatment would more likely than not have saved the limb or meant a less extensive amputation, and the loss of a less than even chance of a better outcome is not recoverable in itself (Gregg v Scott [2005] 2 AC 176). Where the damage built up over time and medical science cannot say how much earlier treatment would have saved, the court may still find causation if the delay made a more than negligible contribution to the injury (Bailey v Ministry of Defence [2008] EWCA Civ 883).
Does an orthopaedic or vascular expert address a missed compartment syndrome?
It depends on which team was responsible. After a fracture the patient is usually under the orthopaedic surgeons, so an orthopaedic expert addresses breach of duty; after arterial surgery or an operation to restore blood flow to a limb, a vascular surgeon does. Causation turns on whether an earlier fasciotomy, the operation that releases the pressure, would on the balance of probabilities have avoided or reduced the muscle and nerve damage.
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