Two common types of Ohio medical malpractice claims arise out of delays in treating aortic abdominal aneurysms (AAAs): failure to perform a AAA repair in the face of a growing aneurysm and failure to emergently diagnose and treat a symptomatic AAA. AAAs are part of a broader category of thoracic aortic disease (TAD), which also includes aortic dissections. The incidence of TAD has tripled in the last two decades, as the population ages. Traditionally, the treatment of choice has been open surgery. But the risk associated with open repair increases with age.
In recent years, attention has been given to endovascular solutions to TAD. Contrasted with open repair, where the aorta is accessed via a large incision, endovascular repair is less invasive as the vein is accessed internally using a catheter threaded through the venous system. You can read more about this here: http://circ.ahajournals.org/content/121/25/2780.full.pdf.
At Mishkind Kulwicki Law, we have investigated two types of medical malpractice claims involving AAA repair. First, older patients are often screened for AAAs using serial ultrasounds. Once an aneurysm reaches operable size, the patient should be advised about repair. Failure to screen resulting in delayed diagnosis, or delay in treatment when the screening ultrasound shows that an aneurysm has reached operable size, are potentially actionable. Likewise, operating before an aneurysm reaches operable size, based on faulty measurements or overly aggressive management, may be grounds for a lawsuit.
The second type of case arises out of delays in diagnosis when a patient develops symptoms of an AAA, a rupture or dissection. TAD, including a large AAA, may occasionally be accompanied with symptoms such as pulsating sensations in the abdomen and/or pain in the chest, lower back or scrotum. This may be an indication for surgery. Upon rupture or dissection, symptoms intensify with the onset of excruciating pain and hypotension. Rapid diagnosis and repair offers the only chance of survival.
Another consideration for AAA cases is that complication rates, including mortality, are reduced when surgery is performed at a high volume center. Thus, as part of the informed consent process for non-emergency cases, the surgeon must disclose to the patient that he/she has limited experience with the repair procedure when that is the case.