This case involves a patient with peripheral artery disease. The patient presented to a vascular surgeon, based in Montana, with symptoms of poor circulation in the legs. The defendant physician indicated that the patient had significant circulation issues and, as such, a corrective procedure was recommended. The patient was discharged following the operation. Several days after the operation, the patient presented to the defendant’s office. The patient had several symptoms, many of which seemed to be beyond what would be expected during recovery from this surgery. The patient became increasingly ill and incapacitated over the course of the following weeks, going to several different hospitals with a variety of complaints including fever and chills. Finally, a colonoscopy was performed, which revealed that the colon had been breached during the original surgery. The corrective structures that had been put in place during the original procedure had allowed for the infiltration of fecal matter into the body, causing severe cardiovascular issues. The patient required several additional major operations to repair the damage. The corrective structures were removed, and several additional complications were discovered, requiring further surgical correction.
Question(s) For Expert Witness
- 1. How often do you perform these procedures?
- 2. Do you have extensive experience treating patients with graft erosions?
- 3. What checks/protocols should be taken to ensure removal and replacement of graft does not cause suffer complications such as infections?
Expert Witness Response E-000214
I have done at least several hundred of these procedures in my career and currently do 2-3 per month. Similar procedures would include repair of Aortic aneurysms in an open manner and Aorto-iliac and aorto-femoral bypasses, and I am very familiar with all of these. This is definitely not a routine complication and would always violate the standard of care. There could have been a direct perforation of the colon at the time the tunnel was made for the right limb of the graft, but most likely that did not occur. I suspect that the colon was left in a position very close to the graft and erosion occurred. Because of the speed (several weeks at most) at which it occurred there must have been a combination of the two; namely, the colon or its blood supply was damaged at the time and the erosion occurred. Either way, it is not acceptable. I would be happy to review and feel the plaintiff has a strong case.