North Carolina – Vascular Surgery – Abdominal Aortic Aneurysm 8.3 cm In Size With Large Type I Endoleak

On 3/31/12, a 76-year-old male with a history of heart disease, chronic obstructive pulmonary disease (COPD), prior endovascular repair of a large abdominal aortic aneurysm (AAA) in 2010 at an outside hospital (OSH) presented to the VA Medical Center emergency department with complaints of back, flank, and hip pain.

On 4/1/12 in the early morning, the patient had a CT scan with contrast which revealed an 8.3 cm AAA with large Type I endoleak.  There was retroperitoneal stranding consistent with an aneurysm rupture.  At 7:45 a.m., these findings were communicated to the emergency department physician.

At 8:00 a.m., the patient was evaluated by a vascular surgeon.  Based on the vascular surgeon’s interpretation of the CT films and the patient’s clinical presentation, the vascular surgeon recommended admission for observation with a follow-up consultation with orthopedic surgery and interventional radiology.

The patient was admitted to the medical ward for the next three days during which he continued to have severe ongoing pain that was managed with pain medications.

On 4/4/12, the patient had a precipitous decline in his clinical status with severe hemodynamic compromise.  A repeat CT scan demonstrated a ruptured AAA with aortocaval fistula.  The patient was taken to the operation room where the vascular surgeon performed an open repair of the aortocaval fistula and ruptured AAA.  However, the patient suffered extensive operative blood loss, perioperative myocardial infarction, and neurological injury.

The patient survived the procedure but remained critically ill.  Over the next several days, the patient improved to a certain degree, but it was felt that the patient had suffered brain injury with little chance for meaningful recovery.

On 4/9/12, supportive measures were withdrawn, and the patient died.

In January 2017, the Board received information regarding a medical malpractice lawsuit settlement payment related to the care provided by the vascular surgeon to the patient.

The Board obtained the patient’s records and sent them to a qualified independent medical expert for review.  The independent medical expert judged the vascular surgeon’s conduct to be below the minimum standard of competence given failure to adequately diagnose and aggressively treat the patient’s symptomatic, ruptured AAA despite evidence of the patient’s life-threatening condition.

The vascular surgeon was reprimanded.

The Board reported the Consent Order to the Federation of State Medical Boards.and the National Practitioner Data Bank.

State: North Carolina

Date: July 2017

Specialty: Vascular Surgery, Emergency Medicine

Symptom: Back Pain, Pelvic/Groin Pain

Diagnosis: Aneurysm, Post-operative/Operative Complication

Medical Error: Delay in proper treatment

Significant Outcome: Death

Case Rating: 4

Link to Original Case File: Download PDF

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