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Vascular Disorders

Overview

The vascular system is made up of veins and arteries. Vascular surgery deals with blood vessels throughout the body (except the heart and skull).

Vascular disorders include deep vein thrombosis (DVT), Pulmonary Embolism (PE), stroke (cerebrovascular accident or CVA), mini-stroke (transient ischaemic attack or TIA), brain haemorrhage, aortic aneurysm and compartment syndrome.

Common arterial conditions and treatment that feature in clinical negligence claims include:

  • ischaemia and amputation
  • aneurysm
  • complications of surgery or radiology
  • compartment syndrome
  • trauma

The standard of care in vascular medicine is constantly improving due to new technology and therapies being developed and it is essential that doctors keep up with these changes if vascular injury is to be avoided.

Claims involving vascular disorders often relate to delayed diagnosis, inadequate treatment and surgical errors, for example damage to blood vessels and nerves which can cause heart attack, paralysis and amputation. Awareness of the relevance of risk factors is crucial to the diagnosis and treatment of arterial and venous disease. Failure to elicit these factors in history taking may lead to vascular diagnoses being missed.

Failure to adequately consent patients for a particular type of treatment is not usually a sole ground for claims but when coupled with other defects in management, may amount to negligence.

Correct and prompt treatment is essential.

Deep Vein Thrombosis

Deep vein thrombosis (DVT) is a blood clot that develops within a deep vein in the body. It usually occurs in a large deep vein that runs through the muscles of the calf and the thigh. DVT can lead to complications such as pulmonary embolism, where the blood clot breaks up and part of it travels through the heart into the lungs. DVT can also lead to post-thrombotic syndrome which causes long term disability including chronic leg ulceration.

Symptoms of a DVT

DVT does not always produce symptoms, but when it does, the common signs are pain, swelling and tenderness in one of the legs (usually the calf), a heavy ache or warm skin in the affected area or red skin, particularly at the back of the leg below the knee.

Causes of a DVT

People at increased risk of developing DVT include those who have undergone surgery or experienced physical trauma and so have been inactive for more than three days. Obesity, diabetes and pregnancy are also risk factors. It is important for doctors to recognise patients at risk of a DVT and take appropriate measures to try to prevent them from developing.

DVT Diagnosis

Diagnostic tests include A D-dimer blood test which detects small pieces of blood clot loose in the blood; a special ultrasound scan called a Doppler test which measures the speed of blood flow; another specialist ultrasound called a duplex scan; and a venogram which involves injecting dye into a vein in the foot which then travels up the leg and shows up any blockages on an Xray.

How to Prevent a DVT

Preventative measures include anti-embolism stockings, foot impulse devices and intermittent pneumatic compression devices.

Treatment of a DVT

Pharmaceutical treatment includes anti-coagulation medication such as heparin and warfarin, Xa inhibitors or direct thrombin inhibitors. Surgical solutions include insertion of a vena cava filter- a small metal device which catches blood clots and stops them going to other parts of the body. Occasionally surgical removal of the clot by venous thrombectomy is required.

DVT Negligence Claims

We have experience of acting for clients for who have suffered injury as a result of failures to identify those at risk, diagnose or appropriately treat those suffering from a DVT.

If you would like legal advice about failure to manage the risks of DVT, or a delay in diagnosis and treatment of DVT, please call our specialist clinical negligence solicitors.

Strokes

A stroke happens when insufficient blood gets to the brain.

Symptoms of a Stroke

Symptoms generally include weakness or numbness of the face, arm or leg, especially on one side; speech problems; difficulty walking or staying balanced or coordinated; and confusion.

Causes of a Stroke

The risk of a stroke increases as you get older as our arteries naturally become narrower and harder. High blood pressure, diabetes, high cholesterol, smoking, high alcohol intake and an irregular heartbeat can increase your risk of a stroke.

Stroke Diagnosis

Someone suspected of having a stroke may be given an urgent CT scan to identify the location and extent of any bleeding in the brain.

Treatment of a Stroke

Aspirin or powerful clot busting drugs may be given to dissolve blood clots to try to minimise the devastating effect of the stroke. However, the treatment must be given within a short time after its onset.

Stroke Misdiagnosis

It is vital for anyone having a stroke that the condition is recognised and treated as quickly as possible. A delay in diagnosis or treatment can lead to catastrophic outcomes, including brain damage, severe disability or death.

Life after a Stroke

Rehabilitation and regular review by specialist health care professionals is required for stroke patients. There may be other underlying conditions, such as hypertension or raised cholesterol which need to be regulated. Anticoagulant drugs such as heparin and warfarin may be given or statins prescribed.

Stroke Negligence Claims

Where delays occur, or things have gone wrong during medical treatment, the consequences can have a profound effect on the patient's recovery, ability to return to work and to lead a normal life.

If you or a family member have been affected by a stroke which you think may have been inadequately treated, please call our team of specialist clinical negligence lawyers.

Pulmonary Embolism

Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved through the bloodstream from elsewhere in the body.

Symptoms of Pulmonary Embolism

Signs and symptoms of a pulmonary embolism include sudden onset of shortness of breath combined with chest pain and sometimes a feeling of faintness and dizziness. A person with a pulmonary embolism may cough up mucus containing blood or fresh blood.

Causes of a Pulmonary Embolism

Bone fracture or muscle tears can cause damage to blood vessels, leading to clots. Also inactivity or certain medical conditions which cause the blood to clot easily can cause a PE. There is a chance of developing a pulmonary embolism after suffering from a DVT or after surgery.

Pulmonary Embolism Diagnosis

Diagnostic tests include a blood test to look for a protein called D-dimer; Computerised Tomography Pulmonary Angiography (CTPA) to look at blood flow in the lungs; a ventilation-perfusion scan, or isotope lung scan, to examine the flow of air and blood in the lungs; and ultrasound scans to look for a clot in the leg. Lifesaving anticoagulant medication such as warfarin or heparin are given to reduce the clot and thin the blood. After recovery, regular blood tests and follow up is necessary.

Pulmonary Embolism Misdiagnosis

However, the signs of a pulmonary embolism can be subtle and sometimes mimic other diseases such as acute coronary syndrome, pneumonia, chronic obstructive pulmonary disease (COPD), aortic dissection (a tear in the inner layer of the large blood vessel branching off the heart) or pneumothorax (collapsed lung).

To prevent a pulmonary embolism, a doctor should consider if you are at greater risk, for example, due to previous DVT, sticky blood (thrombophilia), age, obesity or immobility.

Pulmonary embolism can be fatal if left untreated and is the most common cause of death in hospital patients and of maternal death in pregnancy.

Compensation for Pulmonary Embolism

We are experienced in dealing with claims arising from failure to take preventative action, failure to diagnose and failure to commence timely treatment. If you or a loved one has had a pulmonary embolism and suspect there may have been a worse outcome as a result of substandard medical care, speak to one of our clinical negligence specialists for advice.

Brain Haemorrhage

A brain haemorrhage is a type of stroke which causes bleeding in or around the brain. It can arise from a ruptured aneurysm (a bulge in a blood vessel caused by a weakness in the blood vessel wall) or after a blow to the head.

There are different types of brain haemorrhage named by reference to the part of the brain affected.

Symptoms of Brain Haemorrhage

Symptoms include a sudden severe headache, seizures for the first time, arm or leg weakness, nausea or vomiting, reduced alertness, lethargy, changes in vision, tingling or numbness, difficulty talking or understanding others.

Symptoms of a subarachnoid haemorrhage include a sudden severe headache which is like nothing the person has experienced before (sometimes called a thunderclap headache), a stiff neck, nausea and vomiting, light sensitivity (photophobia) blurred or double vision, stroke-like symptoms such as slurred speech and one-sided weakness, loss of consciousness or uncontrollable shaking.

Causes of a Brain Haemorrhage

Causes and risk factors of a brain haemorrhage include head trauma, high blood pressure, an aneurysm (weakening in a blood vessel that swells), blood vessel abnormalities, blood or bleeding disorders, a brain tumour and liver disease.

Diagnosis of a Brain Haemorrhage

A CT scan or MRI scan is usually used to check for signs of a brain haemorrhage.

You may also have a test called a lumbar puncture. A lumbar puncture involves a needle being inserted into the lower part of the spine so a sample of the fluid that surrounds and supports the brain and spinal cord (cerebrospinal fluid) can be taken out and checked for signs of bleeding.

Intracranial Haemorrhage Treatment

Treatment may include the prescription of painkillers, steroids or diuretics to reduce swelling or anticonvulsant drugs to control seizures.

For a subarachnoid haemorrhage, coiling or clipping may be carried out under general anaesthetic. Coiling involves placement of a thin catheter into an artery in the leg or groin and up into the head, through which tiny platinum coils are passed into the aneurysm. Once the aneurysm is full of coils, blood cannot enter it and it cannot rupture again. In clipping, a cut is made in the scalp or sometimes just above the eyebrow and a small flap of bone is removed so the surgeon can locate the aneurysm. A tiny metal clip is the fitted around its base to seal it shut.

Effects of a Brain Haemorrhage

The long-term effects of a brain haemorrhage depend on the type and location of the haemorrhage. These can include communication and language problems, loss of memory, disinhibition, impulsiveness, obsessive behaviour, problems with planning and organisation, reduced concentration, impaired reasoning, aggression and irritability. However, every person's recovery is different.

Brain Haemorrhage Claims

You may have a claim for clinical negligence if you have suffered a delay in diagnosing and treating a brain haemorrhage. You may also have a claim if you have suffered a brain haemorrhage because your doctor has not properly monitored and managed your blood pressure or regular anticoagulation treatment.

If you have any concerns, please call one of our dedicated clinical negligence solicitors who will be able to advise you whether or not you have a viable claim.

Aortic Aneurysm

An aortic aneurysm is a bulge or swelling in the aorta, the main blood vessel that runs from the heart down through the chest and abdomen. The aneurysm is most often abdominal but can be thoracic (higher up in the chest).

Symptoms of an Aneurysm

Symptoms include a pulsing sensation like a heart beat in the abdomen or relentless tummy or back pain. Sometimes however there are no symptoms and the aneurysm is discovered when tests are carried out to investigate other conditions.

An aortic aneurysm can be dangerous if not diagnosed early because it may continue to grow until eventually it bursts. Symptoms of a ruptured aortic aneurysm include a sudden, severe pain in the tummy or lower back, feeling clammy and dizzy, an increased heartbeat or shortness of breath and loss of consciousness. Life threatening bleeding occurs and complications can then result such as heart attack, stroke or kidney failure.

Causes of Aneurysm Rupture

Risk factors for aortic aneurysms include smoking, high blood pressure or high cholesterol. Sometimes, patients will have a family history of aneurysms.

Diagnosis of an Aneurysm

Accident and Emergency doctors must be able to recognise the symptoms of a possible ruptured aneurysm and arrange urgent investigations, including and MRI scan and a angiograpgy (MRA) or a Ct Scan and angiography (CTA). A ruptured aneurysm can be fatal so it is important that patients get to hospital as soon as possible and receive the correct treatment. Once the diagnosis is made, a surgeon must be called urgently to deal with what could otherwise rapidly become life threatening.

Treatment of an Aneurysm

Brain aneurysms can be treated using surgery if they have burst (ruptured) or there's a risk they will.

Aneurysm Compensation Claims

Failure to diagnose an aortic aneurysm can have very serious consequences and give rise to a clinical negligence claim. If you would like to talk to an experienced clinical negligence solicitor please call the dedicated team at Barlow Robbins.

Compartment Syndrome

Compartment syndrome is a painful and potentially serious condition caused by bleeding or swelling within an enclosed bundle of muscles known as a muscle compartment.

Symptoms of Compartment Syndrome

Symptoms of compartment syndrome include an aching, burning or cramping pain in a specific area (compartment) of the affected limb, or tightness, numbness, tingling or weakness in the affected limb.

Diagnosis of Compartment Syndrome

A doctor can suspect compartment syndrome by an examination of the affected limb and by looking at imaging and blood test results, although a definite diagnosis requirements a measurement of the pressure by a pressure monitor which involves the insertion of a needle. A plastic catheter can also be used.

Causes of Compartment Syndrome

Compartment syndrome occurs when the pressure within a compartment increases, restricting the blood flow to the area and causing ischaemic damage to nerves and muscles. It usually occurs in the legs, feet, arms or hands, but can occur wherever there's an enclosed compartment inside the body.

Acute Compartment Syndrome

Acute compartment syndrome comes on suddenly and can be caused by trauma such as bone fractures. It is key to treat the condition quickly in order to avoid permanent muscle damage. Timely relief of pressure by opening the compartment by surgery (fasciotomy) within the window of opportunity (around 6-8 hours) is critical to avoiding serious tissue damage.

Chronic Compartment Syndrome

Less serious chronic compartment syndrome happens gradually, usually during and immediately after repetitive exercise and usually passes within a few minutes.

Compartment Syndrome Claims

Failure to diagnose and treat acute compartment syndrome can have very serious consequences and can give rise to a clinical negligence claim. If you would like to talk to an experienced clinical negligence solicitor please call the dedicated team at Barlow Robbins.

Acute Ischaemia of Limbs

Acute limb ischaemia happens when there is a sudden lack of blood flow to a limb. This can be extremely serious and require rapid diagnosis and decisive action in order to save the limb and even prevent death. If blood supply to a limb is restored too late it can result in reperfusion syndrome (damage caused when blood supply returns to tissue after a period of ischemia or lack of oxygen) leading to compartment syndrome and commonly to amputation.

Symptoms of Acute Ischaemia

Symptoms of acute limb ischaemia include the following, known as the 6 P’s:

  • Pain
  • Pallor
  • Pulselessness
  • Paresthesia (numbness, pins and needles)
  • Poikiolothermia (coldness)
  • Paralysis

Causes of Acute Limb Ischaemia

Acute limb ischaemia is usually caused by embolism (air, blood clot or fat blockage inside a blood vessel largely obstructing blood flow) or thrombosis (blood clot inside a blood vessel reducing blood flow).

Acute Limb Ischaemia Diagnosis

Acute limb ischaemia can be diagnosed via blood tests, a Doppler Ultrasound Scan, or CT angiography.

Treatment of Acute Limb Ischaemia

Surgery (thromboembolectomy) and bypass grafting is the usual treatment for acute limb ischaemia. Blood thinning drugs such as heparin are also used. In serious cases, amputation may be require to prevent the spread of the ischaemia.

Acute Limb Ischaemia Claims

It is not enough for your doctor to look out for the 6P’s. It is also necessary to understand what the subtle variations and combinations of these symptoms mean. If the condition is missed, you may well have a claim for compensation. A delay in diagnosis can have serious consequences, including amputation. If you would like to talk to an experienced clinical negligence solicitor please call the dedicated team at Barlow Robbins.