MEDICO LEGAL M A G A Z I N E
VASCULAR SURGERY – THE PROBLEM WITH LEGS Mr Michael Gaunt MA, MD, FRCS. Consultant Vascular Surgeon, Cambridge. In previous articles I have described how the speciality of Vascular Surgery is concerned with the diagnosis, assessment and treatment of conditions of the arteries, veins and lymphatics of every part of the body apart from the heart (cardiology/cardiac surgery) and the brain (neurology/neurosurgery). Vascular surgery is a high-risk speciality for medicolegal claims because when problems occur they do so quickly and with severe limb and lifethreatening complications. My previous papers have provided a brief overview of vascular surgery, but in this article, I am going to concentrate on a common problem area for arterial disease – the legs. Medical negligence in this area frequently results in amputation of the limb and longterm disability requiring significant modifications to all areas of a claimant’s life including employment, social life, home life, relationships and life expectancy.
Arterial Conditions Affecting the Legs In general, arteries carry blood rich in oxygen and nutrients to supply the muscles and tissues of the legs. In humans the muscles of the legs are much bigger and require much more arterial blood supply than the arms, therefore, arterial conditions such as atherosclerosis, which causes arterial narrowing/
blockages, have much greater effect. Two situations significantly increase the blood requirement of the leg – exercise and injury/wound healing. Problems occur when the arterial blood requirement of a limb exceeds the ability of diseased arteries to meet that requirement. In exercise this means the muscles go into oxygen debt, produce lactic acid and seize-up – intermittent claudication. In injury/wound healing it means that healing does not occur and in fact wounds deteriorate and extend - the classic example is gangrene of a little toe which extends until the whole leg turns gangrenous. Therefore, all conditions which affect the arteries require timely and accurate assessment and treatment to avoid unnecessary pain and disability. For the purpose of this article I am going to describe conditions according to the common areas of claims: 1. Delays in diagnosis and treatment of acute and chronic arterial conditions 2. Complications of treatment 3. Amputation Acute conditions represent a sudden deterioration in blood supply. These can occur from intrinsic reasons such as an embolus from the heart or aorta, or extrinsic reasons such as a sharp transection of the artery or blunt injury such as overstretching of the
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