CASE REPORT   

Minerva Forensic Medicine 2021 June-September;141(2-3):51-6

DOI: 10.23736/S2784-8922.21.01808-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Legal aspects of lower limbs acute ischemia

Giuseppe BASILE ¹, Marcello GHEZZI ², Chiara BRIOSCHI ³, Luigi F. RINALDI ⁴ ✉, Enrico M. MARONE ^{4, 5}

¹ Unit of Legal Medicine, Clinical Institute San Siro, Milan, Italy; ² Department of Vascular Surgery, Clinical Institute San Carlo, Paderno Dugnano, Milan, Italy; ³ Department of Vascular Surgery, IRCCS Multimedica, Sesto San Giovanni, Milan Italy; ⁴ Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; ⁵ Unit of Vascular Surgery, Policlinico Hospital, Monza, Monza-Brianza, Italy

Acute limb ischemia is a surgical urgency with a well-known impact in terms of mortality and amputation. Early diagnosis and treatment are the key to minimize the consequences of this life- and limb- threatening condition, whereas misdiagnosis and delay are often responsible of the worst prognostic outcomes. This report focuses on the legal allegations that can involve physicians and surgeons dealing with acute limb ischemia. Four cases of misdiagnosed or mistreated acute limb ischemia leading to severe outcomes are compared and all the respective legal implications are discussed, in order to display the most common mistakes, consequences and responsibilities. Four major mistakes can be identified: neglect of the early clinical signs (the 6 Ps) during physical evaluation, delayed treatment, lack of intraoperative assessment of limb revascularization and mistakes in the post-operative monitoring. Final clinical outcomes ranged from minor to major limb amputation, with heavy legal implications for the treating physicians. Malpractice lawsuits allegations for ALI can involve both first-line physicians, in charge of the diagnosis, and vascular surgeons, responsible for the treatment. Every physician, regardless of his specialty, should be able to formulate a first diagnostic suspicion of ALI on a clinical basis, and refer the patient to a vascular surgeon immediately. The specialist, in turn, should ensure prompt treatment, aetiologic assessment and close post-operative monitoring to prevent recurrences.

KEY WORDS: Extremities; Ischemia; Malpractice; Amputation