Review of Malpractice Litigation in the Diagnosis and Treatment of Venous & Lymphatic Disease

Published:August 01, 2022DOI:


      • A total of 144 cases were identified with 41 cases involving varicose veins, 11 spider veins, 35 thoracic outlet syndrome, 17 other venous diseases, and 40 with lymphatic disease.
      • Vascular surgeons were the most frequently identified physician defendant.
      • The majority of cases involved post-procedure complications in the management of these diseases.


      Malpractice claims involving nonthrombotic venous and lymphatic diseases and interventions have not been reported previously. We investigated common reasons for litigation, medical specialties involved, patient injuries, and case outcomes in malpractice litigation involving venous and lymphatic disease.


      Litigation cases entered into the Westlaw database from June 8th, 1984 to February 15th, 2018 were analyzed. Search terms included relevant words and phrases related to nonthrombotic venous, thoracic outlet syndrome, and lymphatic disease and treatment. Data on physician specialty, malpractice claims, and patient injuries jury outcomes, amount awarded to the plaintiff, and jury fees were collected and compared for each category.


      A total of 144 cases were identified. 41 cases involved varicose veins, 11 spider veins, 35 thoracic outlet syndrome (TOS), 17 other venous diseases, and 40 lymphatic diseases. Physician defendants were frequently vascular surgeons (23%) and general surgeons (15%). The majority of litigation claims involved “post-procedure complication” (77%), “lack of informed consent” (25%), “failure to diagnose & treat” (15%), and “intraoperative complications” (13%). The most common injuries were skin damage (27.8%), nerve damage (25%), and lymphedema (24%). Patient death occurred in 6% of cases.
      Out of venous malpractice cases with post-procedure complications, stab phlebectomy (27%) was the most common intervention followed by foam sclerotherapy (21%), rib resection (21%), laser spider vein removal (5%), and endovenous laser ablation therapy (EVLT)(3%). Of varicose vein cases, 15% included deep vein thrombosis or pulmonary embolism as post-procedure complications. In TOS rib resections, 65% of cases referenced nerve damage and 12% involved arterial injury.
      For lymphatic disease cases, general surgeons were frequently identified defendants (25%). Lymphedema (93%) and lymphangitis (7%) occurred as post-procedure complications after breast, gynecologic, orthopedic, and radiation procedures. A majority of complications occurred after breast cases (40%).
      Verdicts overall ruled in favor of the defendant in 71% (102/144) of cases and the plaintiff in 20% (29/144) of cases. Out of cases ruled in favor of the plaintiff, 31% were lymphatics, 24% varicose veins, and 24% TOS cases. Only 8% (12/144) of cases were settled and one outcome was unknown. The mean award was $820,193 (standard deviation SD $1,226,008, Range $12,853 - $6,500,000).


      The majority of venous and lymphatic litigation cases involve claims of post-procedure complications. Venous complications occurred after open and endovascular treatment of varicose veins, spider vein treatment, and surgical management of TOS. Lymphedema occurred after breast, oncology, and orthopedic procedures. These cases reflect opportunities for intervention to help potentially prevent litigation.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Eberhardt R.T.
        • Raffetto J.D.
        Chronic venous insufficiency.
        Circulation. 2014; 130: 333-346
        • Greene A.K.
        Epidemiology and Morbidity of Lymphedema: Lymphedema: Presentation, Diagnosis, and Treatment.
        2015: 33-44
        • Zenati N.
        • Bosson J.L.
        • Blaise S.
        • et al.
        [Health related quality of life in chronic venous disease: systematic literature review].
        J Med Vasc. 2017; 42: 290-300
        • Fu M.R.
        • Ridner S.H.
        • Hu S.H.
        • et al.
        Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011.
        Psychooncology. 2013; 22: 1466-1484
        • Ma H.
        • O'Donnell Jr., T.F.
        • Rosen N.A.
        • et al.
        The real cost of treating venous ulcers in a contemporary vascular practice.
        J Vasc Surg Venous Lymphat Disord. 2014; 2: 355-361
        • Haslett J.J.
        • Genadry L.
        • Zhang X.
        • et al.
        Systematic review of malpractice litigation in the diagnosis and treatment of acute stroke.
        Stroke. 2019; 50: 2858-2864
        • Phair J.
        • Carnevale M.
        • Wilson E.
        • et al.
        Jury verdicts and outcomes of malpractice cases involving arteriovenous hemodialysis access.
        J Vasc Access. 2020; 21: 287-292
        • Thomas R.
        • Gupta R.
        • Griessenauer C.J.
        • et al.
        Medical malpractice in neurosurgery: a comprehensive analysis.
        World Neurosurg. 2018; 110: e552-e559
        • Choinski K.
        • Sanon O.
        • Tadros R.
        • et al.
        Review of malpractice lawsuits in the diagnosis and management of aortic aneurysms and aortic dissections.
        Vasc Endovascular Surg. 2022; 56: 33-39
        • Wilson E.
        • Phair J.
        • Carnevale M.
        • et al.
        Common reasons for malpractice lawsuits involving pulmonary embolism and deep vein thrombosis.
        J Surg Res. 2020; 245: 212-216
        • Phair J.
        • Denesopolis J.
        • Lipsitz E.C.
        • et al.
        Inferior vena cava filter malpractice litigation: damned if you do, damned if you don't.
        Ann Vasc Surg. 2018; 50: 15-20
        • Bal B.S.
        An introduction to medical malpractice in the United States.
        Clin Orthop Relat Res. 2009; 467: 339-347
        • Bal B.S.
        The expert witness in medical malpractice litigation.
        Clin Orthop Relat Res. 2009; 467: 383-391
        • Rubin J.B.
        • Bishop T.F.
        Characteristics of paid malpractice claims settled in and out of court in the USA: a retrospective analysis.
        BMJ Open. 2013; 3: e002985
        • Sivasubramaniam D.
        • McGuinness M.
        • Coulter D.
        • et al.
        Jury decision-making: the impact of engagement and perceived threat on verdict decisions.
        Psychiatr Psychol L. 2020; 27: 346-365
        • Kaplan R.M.
        • Criqui M.H.
        • Denenberg J.O.
        • et al.
        Quality of life in patients with chronic venous disease: san Diego population study.
        J Vasc Surg. 2003; 37: 1047-1053
        • Mallick R.
        • Raju A.
        • Campbell C.
        • et al.
        Treatment patterns and outcomes in patients with varicose veins.
        Am Health Drug Benefits. 2016; 9: 455-465
        • Subramonia S.
        • Lees T.A.
        The treatment of varicose veins.
        Ann R Coll Surg Engl. 2007; 89: 96-100
        • Kabnick L.S.
        • Ombrellino M.
        Ambulatory phlebectomy.
        Semin Intervent Radiol. 2005; 22: 218-224
        • Wood J.J.
        • Chant H.
        • Laugharne M.
        • et al.
        A prospective study of cutaneous nerve injury following long saphenous vein surgery.
        Eur J Vasc Endovasc Surg. 2005; 30: 654-658
        • Almeida J.I.
        • Kaufman J.
        • Gockeritz O.
        • et al.
        Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study).
        J Vasc Interv Radiol. 2009; 20: 752-759
        • Rasmussen L.H.
        • Lawaetz M.
        • Bjoern L.
        • et al.
        Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins.
        Br J Surg. 2011; 98: 1079-1087
        • Bozoglan O.
        • Mese B.
        • Eroglu E.
        • et al.
        Comparison of endovenous laser and radiofrequency ablation in treating Varices in the same patient.
        J Lasers Med Sci. 2017; 8: 13-16
        • Hosseinian M.A.
        • Loron A.G.
        • Soleimanifard Y.
        Evaluation of complications after surgical treatment of thoracic outlet syndrome.
        Korean J Thorac Cardiovasc Surg. 2017; 50: 36-40
        • Rinehardt E.K.
        • Scarborough J.E.
        • Bennett K.M.
        Current practice of thoracic outlet decompression surgery in the United States.
        J Vasc Surg. 2017; 66: 858-865
        • Maqbool T.
        • Novak C.B.
        • Jackson T.
        • et al.
        Thirty-day outcomes following surgical decompression of thoracic outlet syndrome.
        Hand (N Y). 2019; 14: 107-113
        • Jones M.R.
        • Prabhakar A.
        • Viswanath O.
        • et al.
        Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment.
        Pain Ther. 2019; 8: 5-18
        • Rupp J.
        • Hadamitzky C.
        • Henkenberens C.
        • et al.
        Frequency and risk factors for arm lymphedema after multimodal breast-conserving treatment of nodal positive breast Cancer - a long-term observation.
        Radiat Oncol. 2019; 14: 39-41
        • Gillespie T.C.
        • Sayegh H.E.
        • Brunelle C.L.
        • et al.
        Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments.
        Gland Surg. 2018; 7: 379-403
        • Beesley V.
        • Janda M.
        • Eakin E.
        • et al.
        Lymphedema after gynecological cancer treatment : prevalence, correlates, and supportive care needs.
        Cancer. 2007; 109: 2607-2614
        • Schizas C.
        • Foko'o N.
        • Matter M.
        • et al.
        Lymphocoele: a rare and little known complication of anterior lumbar surgery.
        Eur Spine J. 2009; 18: 228-231
        • Mohapatra B.
        • Kishen T.
        • Loi K.W.
        • et al.
        Retroperitoneal lymphocele after lumbar total disc replacement: a case report and review of literature.
        SAS J. 2010; 4: 87-91
        • Kell M.R.
        • Kerin M.J.
        Sentinel lymph node biopsy.
        BMJ. 2004; 328: 1330-1331
        • Kesselheim A.S.
        • Studdert D.M.
        Characteristics of physicians who frequently act as expert witnesses in neurologic birth injury litigation.
        Obstet Gynecol. 2006; 108: 273-279
        • Lynn-Macrae A.G.
        • Lynn-Macrae R.A.
        • Emani J.
        • et al.
        Medicolegal analysis of injury during endoscopic sinus surgery.
        Laryngoscope. 2004; 114: 1492-1495
        • Hong S.S.
        • Yheulon C.G.
        • Sniezek J.C.
        Salivary gland surgery and medical malpractice.
        Otolaryngol Head Neck Surg. 2013; 148: 589-594