Acute Aortic Disease.. - Index of

Legal Considerations in Acute Aortic Diseases 337
(ascending) and two Type B (descending)], and two involved miscellaneous other
phenomena (one coarctation and one iatrogenic descending aortic rupture).
It is noteworthy that two cases involved peripartum aortic dissection in
young, childbearing women.
Of the 30 patients, 27 had died at the time the suit was filed, and of the remaining
three, two had paraplegia and one had a major cerebrovascular accident.
The allegations centered around the following issues:
1. Failure to make a diagnosis or delayed diagnosis in 17
a. eleven failure to make antemortem diagnosis and
b. six delay in diagnosis,
2. Delay in surgical therapy in four,
3. Error in surgical technique in four,
4. Failure to prevent paraplegia in two, and
5. Miscellaneous in three (failure to restrict activities, improper preoperative
care, improper postoperative care).
The physicians being sued were often multiple and included emergency
physicians, radiologists, cardiac surgeons, vascular surgeons, cardiologists, internists,
and obstetrician–gynecologists.
FINDINGS
The reviewing physicians felt that medical care delivered was suboptimal in 21
cases and satisfactory in nine. This designation was not based on legal definitions
of standard of care, but rather on whether or not retrospective case review revealed
substantive diagnostic or therapeutic instances where care could have been
improved.
In this review, it was found that litigation for nontraumatic thoracic aortic
diseases involved the following categories of alleged malpractice, in decreasing
order of frequency: failure-to-diagnose (or delay in diagnosis), delay in
surgical therapy, error in surgical technique, failure to prevent paraplegia, and
miscellaneous.
The seriousness of these cases is apparent in the sobering fact that, of the
30 patients, 27 were dead at the time of the lawsuits and the remaining three
were permanently impaired by paralysis or stroke. This statistic underscores the
highly lethal nature of thoracic aortic aneurysm and dissection. Mistakes, delays,
and failure to include aortic diseases in the differential diagnosis can easily result
in patient mortality or devastating debility.
Of all types of aortic disease resulting in lawsuits, Type A dissection
predominates by a wide margin, accounting for 60% of our reviewed cases.
Helpful corollaries can be drawn from the observation in this study of the
existence of several major patterns—both clinical and legal—for these aorticrelated
lawsuits. These patterns will be examined individually, category by
category.