Abdominal Aortic Aneurysms

An abdominal aortic aneurysm is an abnormal enlargement or ballooning of the abdominal aorta, the large blood vessel supplying blood to the abdomen, pelvis and legs.

This is a common aliment. About 4% of us over the age of 65 have an abdominal aortic aneurysm. Incredibly, prevalence of these aneurysms has tripled over the past 30 years, probably because our society is getting older. The United States Preventive Services Task Force recommends that all men who have ever smoked be screened at least once for abdominal aortic aneurysms between 65 and 75 years of age.

aneurysm

As many as 60% of cases of abdominal aortic aneurysms are incorrectly diagnosed by first-contact practitioners, leading to delays in surgery. This is an incredible statistic. The best hope of survival in these cases is prompt diagnosis and treatment. When an abdominal aortic aneurysm ruptures, the complications that can ensue are a who's who of bad things that can happen to a person: arterial embolism, heart attack, hypovolemic shock, kidney failure, and stroke.

Accordingly, misdiagnosis of aortic aneurysms often cause severe injury and death. Abdominal aortic aneurysms are the 14th leading cause of death - something few people seem to know, including doctors - in the US. It is estimated that 4,500 deaths are attributed to an abdominal aortic aneurysm rupture in the U.S. and an additional 1,400 deaths result from procedures to repair the aneurysm and prevent rupture.

The take-home message is that you can’t dilly-dally with this condition. If the doctors don’t identify it quickly and get a patient to the operating room, there is a strong likelihood the patient will die. This is outside the box for many doctors who – appropriately in most cases – like to test and test to get their diagnosis straight. But if you wait around for a CT scan, you very well may lose the patient.

According to an article from the Annals of Vascular Surgery, they underscore how important it is to catch these aneurysms quick: “All patients who had extensive diagnostic evaluation lasting more than 5 hours died… the only diagnostic procedure that definitively established aortic aneurysm in all cases was the CT scan.” The failure to diagnose an abdominal aortic aneurysm is usually because the doctors confuse the condition with something else. Often, doctors incorrectly misdiagnosis a kidney condition.

If you think you have a potential wrongful death medical malpractice claim for someone you loved because the ER doctor or another doctor failed to diagnose an abdominal aortic aneurysm, call 800-553-8082 to discuss your potential case or get a free online case evaluation.

Symptoms of Abdominal Aortic Aneurysms

Aneurysms are slow to develop, taking years, and are often asymptomatic (without symptoms). Symptoms may develop suddenly if an aneurysm ruptures (tears open). Symptoms of rupture include severe, sudden or constant pain in the abdomen or back that may radiate to the groin, legs or buttocks; clammy skin; nausea; vomiting; rapid heart rate; and shock.

Risk Factors for Abdominal Aortic Aneurysms

The precise cause of abdominal aortic aneurysms is not known. Risk factors that have been associated with abdominal aortic aneurysms include smoking, age, ethnicity (with Caucasians at highest risk), hypertension (high blood pressure), high cholesterol, emphysema, obesity and genetic factors. Abdominal aortic aneurysms are more prevalent in men over the age of 60 with one or more of the previously mentioned risk factors. But these tragedy can hit anyone.

Diagnosis of Abdominal Aortic Aneurysms

Abdominal examinations and evaluation of pulses and feeling in ones legs are often the first step in diagnosing aortic aneurysms. Signs that may be found by the examining doctor may include a lump in the abdomen, pulsating sensation in the abdomen, or a stiff or rigid abdomen. The problem could also be found in asymptomatic patients through ultrasound or CT scan of the abdomen, and these tests are performed as well in patients presenting with symptoms of abdominal aneurysms. X-rays are sometimes helpful in the diagnosis of abdominal aortic aneurysm rupture, as they do not show presence of blood. Accordingly, CT scans are usually performed as well.

Up to 87% of patients who make it to an emergency room are stable enough for a CT scan. The delay in operation associated with CT scans are a real problem bu have not been demonstrated to increase the rate of deaths. So CT scans are the most appropriate test to ensure proper diagnosis and treatment of patients presenting to the emergency room with an abdominal aortic aneurysm.

Many of these cases are claims against the radiologist. The most prolific example of this is the John Ritter case that settled for $14 million.

Sampling of Aortic Aneurysm Medical Malpractice Verdicts

Aortic aneurysm medical malpractice cases are all too common. As a result there are a large number of plaintiffs' verdicts in these cases around the country. This is an unrepresentative sampling of relatively recent plaintiffs' aortic aneurysm verdicts and settlements:

  • June 2013, Illinois: $595,000 Verdict: A 55 year-old housewife arrives at Rush North Shore Medical Center where she undergoes surgery to repair and abdominal aneurysm. Shortly following the surgery, the woman begins to suffer from severe ischemia – an inadequate supply of blood to a particular part of the body – in her right foot. For the next several months she is required to undergo multiple surgical procedures in an attempt to repair the irregular blood flow into her foot. Unfortunately, her foot became gangrenous and eventually her forefoot needs to be amputated. The plaintiff sues the hospital and surgeon for medical malpractice. Plaintiff’s counsel claims that the defendant chose to clamp the aorta first. Plaintiff’s vascular surgeon expert testifies the aorta should only have been clamped after clamping the iliac arteries. He claims that the improper clamping sequence was the cause of the plaintiff’s injuries. Both parties agree that doing so would be a deviation from the standard of care to clamp the aorta first and the jury finds in favor of the plaintiff.
  • March 2013, Massachusetts: $3,000,000 Settlement: An elderly man arrives at an urgent care center complaining of flank and groin pain. While there, it is noted that his blood pressure has also elevated and there is blood in his urine. The attending physician diagnosis the man with a kidney stone and schedules a renal ultrasound for the next day. The man returns the following day for the ultrasound and the results come back negative. The physician suggests the man should schedule a CT scan with his primary care doctor and informs him that if the pain were to increase, he should go to the emergency room. The next morning, the man is discovered by his to be in great distress. An ambulance is called and he is rushed to the hospital where he is diagnosed with a ruptured abdominal aortic aneurysm. During an emergency surgery, it is realized that the man had lost a large quantity of blood. A second surgery is required where it is found that a portion of his bowel tissue had died. The man’s blood loss ultimately leads to a diagnosis of ischemia, which requires the man to undergo skilled nursing rehabilitation for about six months. The man files a medical malpractice suit against the urgent care physician for failing to timely diagnose the aortic aneurysm. He alleges that an abdominal aortic aneurism can leak prior to rupture and that such a leak creates symptoms identical to the ones he presented upon his initial visit. The defendant argues that when the plaintiff visited the urgent care center, the aneurysm had not yet ruptured and his complaints were not consistent to a ruptured abdominal aortic aneurysm. The parties agree to settle before trial for $3,000,000.
  • 2012, New York: $750,000 Settlement. Wrongful death case involving a 55 year-old man who had an aortic aneurysm three year before. Emergency room did not rule out aortic aneurysm when he presented with chest pain and gave him blood thinners and failed to address man's rising blood pressure.
  • 2011, Maryland (Montgomery County): $730,000 Verdict. A Rockville housekeeper arrives at the emergency room complaining of abdominal and back pain. She is diagnosed with an aortic aneurysm with a measured diameter of 4.1 centimeters and discharged. Four months later, she returns to the emergency room with the same complaints. The emergency room physicians conduct an ultrasound and find the aneurysm has gown to 4.3 centimeters in diameter. They choose to admit her into the hospital. Upon observing the woman, a vascular surgeon diagnoses the aneurysm as being an expanded 4.8 centimeters. Even though a second doctor advisees that the woman only needs observation, the surgeon decides the aneurysm is in need of repair. He claims that the aneurysm was rapidly expanding and if it is left unattended to, could result in death. An endoscopic procedure is conducted and the aneurysm is repaired. Following the procedure, the woman begins to experience pain in her right buttock, calf and thigh. She begins to experience pulseless activity in the right leg and is soon diagnosed with having a blocked iliac artery. A necessary surgery is conducted to help the woman restore natural blood flow to her leg. Unfortunately, she still suffers from daily leg pain and will permanently walk with a limp. The woman brings a medical malpractice suit to the vascular surgeon, claiming that he violated the standard of medical care for inaccurately measuring the aortic aneurysm. She claims the surgeon conducted the procedure with a 7 mm instrument on 4 mm arteries, which caused the irregular blood flow. The defendant denies all liability, arguing that the treatment provided for the plaintiff was well within the standard of care. The jury finds in favor of the plaintiff and awards her $730,325.
  • 2011, Virginia: $975,000 Settlement: A 68 year-old woman is informed that she is in need of surgery to repair an abdominal aortic aneurysm. Just two days before the day of surgery, the woman is informed that her initial surgeon does not feel comfortable conducting the surgery because he felt it is beyond his skill and experience. He refers her to another surgeon who is noted for having extensive experience in conducting such surgeries. Without the referring surgeon’s knowledge, the new surgeon offers the woman two surgical options: repair just the abdominal aortic aneurysm or undergo a more extensive repair that would not only repair the abdominal aortic aneurysm but also the descending thoracic aneurysm. She is informed that the second surgical option is a higher risk because not only would they be operating on her abdomen, but her chest as well. The woman decides on the morning of the surgery to undergo the more extensive option. While under anesthesia, the woman goes under an extended period of hypoxia and hypotension. The woman awakes to find she has lower extremity paraplegia and renal failure and now requires extended hospitalization. Unfortunately, the paraplegia never lifts and she passes from respiratory failure. The woman’s estate brings a wrongful death and medical malpractice suit against performing surgeon. During investigation, the anesthesiologist testifies that he was unwilling to provide anesthesia for the surgery if the defendant chose to enter the chest due to complication the defendant had experienced with previous surgeries – meaning this defendant had problems with such procedures before and still offered to do the same to this woman. Plaintiff claims that pre-operative imaging showed going anywhere but the abdomen was completely unnecessary. The defendant denies liability, but the parties choose to settle for $975,000.
  • 2009, Maryland: $600,000 settlement. Wrongful death case where 76 year-old woman allegedly died during an endoscopic vascular repair of an abdominal aortic aneurysm. Claim involved allegations that the surgical team used a balloon during the repair of the aneurysm that was too big for the iliac artery, rupturing a vessel that caused the woman's death.
  • May 2008, Indiana: $4,450,000 Verdict: An Inland Steel security supervisor is not feeling well and is finding it difficult to walk. While seated to prevent any additional dizziness, he falls off his chair and into a seizure. He is rushed from his job to St. Catherine’s Hospital in East Chicago. While in the emergency room he is diagnosed and treated for kidney stones. He is brought back home by his wife who leaves him to rest while she and her daughters go out to finish Christmas shopping. Upon their return, his wife finds her husband in bed and unresponsive. The husband and father of three is pronounced dead shortly thereafter from a ruptured abdominal aortic aneurysm. The surviving family attempts to bring the case under review by the hospital medical panel, but is turned away by the panel’s opinion that no standard of care was breached. They decide to bring the diagnosing physician to suit for medical negligence for failing to properly handle the decedent’s complaints. Plaintiff experts testify that had the defendant ordered a CT scan, the results would have revealed the decedent’s aneurysm. They claim that doing would have more than likely saved the man’s life. The defendant denies negligence and claims that after conducting a thorough physical examination and appropriate testing, he reached a reasonable diagnosis. He points fault at the decedent for failing to properly provide accurate information of his complains. After a five day trial, the jury finds in favor of the plaintiffs, awarding them $4,450,000.
Treatment and Outcomes

Open abdominal aneurysm repair will be performed in cases where internal bleeding from an aortic aneurysm occurs. If the aneurysm is small and no symptoms are present, regular monitoring by ultrasound is often recommended to see if the aneurysm is enlarging. In some cases surgery may be advised, usually in cases where the aneurysms are larger than 2 inches, or for rapidly growing aneurysms, with the goal being to perform the surgery prior to complications.

Misdiagnosis of Abdominal Aortic Aneurysms

The classic symptoms of abdominal or back pain, hypotension, and a pulsatile abdominal mass are absent in more than 60% of the cases of ruptured abdominal aortic aneurysms. Misdiagnosis by emergency physicians is a serious concern. Varied and nonspecific symptoms lead to erroneous diagnoses and cause significant delays in proper intervention. Despite advances in definitive treatment and imaging, the only means of improving early detection and survival is a heightened awareness among emergency room doctors and referring general practitioners.

There is no doubt that this diagnosis is often missed, often by doctors who are not looking carefully at all of the patients symptoms. How often are aeortic aneurysms missed? In a retrospective study of 152 patients at the University of North Carolina, 30% were initially misdiagnosed. Misdiagnosis of abdominal aortic aneurysm rupture has been reported to occur at a rate as high as 60%. The most common misdiagnoses were diverticulitis, gastrointestinal hemorrhage, and renal colic. Patients most commonly presented with abdominal pain, shock, and back pain. However, these symptoms were not found in all subjects, rather only 50-70% of patients presented with one or more of these symptoms, and only one quarter of the patients were found to have a pulsatile abdominal mass in misdiagnosed patients.

Atypical symptoms make it challenging to properly diagnose as symptoms may be similar to renal colic, diverticulitis, gastrointestinal perforation/hemorrhage, urinary tract infection, the presence of a cyst, and spinal disease. Abdominal aortic aneurysm rupture is generally not suspected in stable patients who present without any truncal pain or collapse, a mistake that can prove fatal.

Mortality can be decreased if the aneurysm is correctly diagnosed and treated before shock develops. Thus prompt and accurate diagnosis is imperative for proper treatment and the best chance for a favorable outcome. But, clearly, an erroneous diagnosis or an incorrect response to a timely diagnosis of a blockage of the aorta can be fatal.

Abdominal Aortic Aneurysms and Other Medical Malpractice Claims in Maryland

Aortic aneurysms and aortic dissections can usually be treated when properly diagnosed. But they are frequently missed by emergency room and primary care doctors and, too frequently become the subject of a wrongful death medical malpractice claim. If you think you have a potential wrongful death malpractice claim for someone you loved because a doctor failed to diagnose an abdominal aortic aneurysm, call 800-553-8082 to discuss your potential legal case or get a free no obligation case evaluation.

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