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

Published:August 01, 2022DOI:https://doi.org/10.1016/j.avsg.2022.07.002

      Highlights

      • 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

      Abstract

      Objectives

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

      Methods

      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, patient injuries jury outcomes, amount awarded to the plaintiff, and jury fees were collected and compared for each category.

      Results

      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 disease. 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 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 (SD $1,226,008, Range $12,853 - $6,500,000).

      Conclusions

      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.

      Keywords

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