Bleeding complications following femoral angiographic access
Bleeding complications following angiographic interventions have recently become an increasing cause of medical malpractice litigation. The reason for this increase is likely a result of several factors including the controversy surrounding the multiple approaches that are currently employed for the treatment of this type of bleeding, as well as the significant morbidity and mortality associated with these treatment paradigms. Allegations in these lawsuits usually include failure to diagnose, failure to treat, failure to transfuse, negligence in the use of an endovascular approach, and negligence in open surgical treatment. Physical examination, close observation, and an aggressive approach to intervention are necessary if litigation is to be avoided in this patient population.
Case 1
The patient underwent cardiac catheterization with placement of a coronary stent. The patient was placed on Integrilin. Following the catheterization, the patient had multiple episodes of hypotension. Each episode responded to fluid boluses and transfusion. No surgical consultation was obtained. The patient’s hemoglobin never fell below 8 grams. The patient was transfused approximately 8 units of blood. The patient’s Integrilin was discontinued. However, the patient progressed to multisystem organ failure and died. Autopsy revealed a massive hematoma of the retroperitoneum and a patent coronary stent. A medical malpractice suit was filed. The case was settled.
Case 2
A patient underwent cardiac catheterization and subsequently developed severe bleeding. She received approximately 10 units of blood prior to vascular surgical consultation. By the time the vascular surgeon saw the patient, the patient was intubated and on vasopressors. The vascular surgeon stated that the patient was not a candidate for surgery. The patient subsequently died. A lawsuit was filed against both the cardiologist and the vascular surgeon. This case was settled by both physicians.
Case 3
A cardiologist calls a vascular surgeon who is at home at 10 p.m. to let her know that he has a patient with a retroperitoneal hematoma following a cardiac cath. He informs the surgeon that the patient is stable. He “just wants her to be aware in case the patient’s condition deteriorates.”
During the night the patient has repeated hypotensive episodes which the cardiologist manages with transfusions. At 5 a.m. the patient arrests and is resuscitated. The surgeon is called, and she takes the patient to surgery but the patient succumbs. The surgeon is sued for not coming in to see the patient and being more involved during the night.
The jury finds in favor of the surgeon. However, the trial took 2 weeks during which time the surgeon had to attend the deliberations and so she was unable work.
