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A recent press article in the Mail Online claims that new research has revealed that ‘four in five limb amputations on the NHS are ‘unnecessary’’. The article sets out concerns that doctors are failing to spot the early signs of Peripheral Arterial Disease.
PAD is a major health problem and the main cause of lower-limb amputations worldwide. This article follows on the heels of a health economics report published in the British Journal of Surgery (BJS). Here I consider some of the issues as a lawyer specialising in acting for clients where there have been problems in the management of vascular diseases such as PAD.
Peripheral Arterial Disease is a common condition where blood supply to leg muscles is restricted by a build-up of fatty deposits in the arteries. Symptoms of PAD can include 'intermittent claudication' which is a painful ache in the legs while walking but which usually disappears after a few minutes of rest. Some other symptoms include ulcers on the feet and legs which do not heal and numbness or weakness in the legs. The risk of developing PAD increases as people grow older and is estimated to affect 20 percent of those over the age of 60. However, those with certain underlying conditions, such as diabetes and high cholesterol, are more at risk. PAD also increases the possibility of developing cardiovascular disease.
An extremely serious complication, which may lead to the need for amputation, is critical limb-threatening ischemia (CLTI). This occurs where the blood flow to the legs becomes severely restricted. Symptoms can include a continuous burning pain in the legs and feet. Limb-saving revascularisation procedures, such as angioplasty and artery bypass graft, may be able to be undertaken. However, one of the authors of the BJS report has been quoted in the Mail article as saying that waiting times are long and that 'there are not enough slots for everyone who needs one'.
According to the BJS study, in the UK in 2021, one quarter of the procedures performed to treat CLTI were primary major lower limb amputations. The study concludes that a shift away from amputations and towards revascularisations could not only benefit patients but also result in substantial savings for the NHS.
Missed opportunities
The report points out that early identification of patients with PAD can improve blood flow and reduce tissue loss, delay or even prevent the need for major surgical intervention and reduce mortality rates. However, the Mail Online article highlights concern over failures to recognise the problem, particularly by GPs.
Data from an earlier study is said to have shown that in primary care, patients with CLTI who had undergone lower-limb amputation had attended an average of 19 primary care consultations in the year before the operation. That study noted that missed opportunities for timely recognition of CLTI could be related to age, deprivation and ethnicity.
Lack of awareness
The BJS report also sets out that there is poor understanding among patients of the causes of PAD and how it progresses. This affects ‘care seeking and compliance’ with some patients trivialising symptoms and attempting self-management rather than consulting health professionals. Among those who do seek a diagnosis there are said to be reports of frustration due to substantial delays as well as a lack of follow-up and information.
The Vascular Society for Great Britain and Ireland has published a best practice clinical care pathway for PAD which advises greater education about the diagnosis and treatment of PAD for GPs, community nurses, podiatrists and doctors from other specialities, as well as patients.
Having seen first-hand the devastating impact of amputations on clients, I very much hope that increased education is implemented and a move towards more revascularisation procedures is going to be possible.
Legal claims
If a delay in diagnosis or treatment of PAD or CLTI has led to an amputation then there may be a claim for clinical negligence. To be successful in such a claim it must be shown that medical care/treatment was negligent and that this caused injury. This can be complex in terms of showing how a progressive disease such as PAD would otherwise have developed and how effective earlier treatment would have been. A specialist solicitor will be able to advise fully. Expert evidence will be needed from various disciplines such as vascular surgery. It is important that experts who are leaders in their fields are instructed.
The Clinical Negligence team at Kingsley Napley are highly experienced in the complexities surrounding claims for medical negligence regarding vascular disease. If you would like to discuss a claim, please do not hesitate to contact our friendly team for a no obligation discussion on 020 7814 1200.
Further information
If you have any questions regarding this blog, please contact James Bell in our Medical Negligence and Personal Injury team.
About the author
James Bell is the head of our Medical Negligence and Personal Injury practice and joined the firm in 2023 from Hodge, Jones & Allen. He has undertaken medical negligence and personal injury cases for over 30 years.
We welcome views and opinions about the issues raised in this blog. Should you require specific advice in relation to personal circumstances, please use the form on the contact page.
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