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Abstract

This article explores some of the main legal implications of abdominal aortic aneurysm (AAA) scanning and treatment, particularly in relation to the interpretation of AAA scans, the provision of patients with adequate information about their options and the risks involved, and issues in relation to monitoring, re-scanning and re-calling the patient for further assessment and treatment. It is suggested that the introduction of national AAA scanning programme is likely to lead to an increase in litigation claims in this field, and that, given the complex nature of the risk–benefit assessment in relation to AAA treatment, particular care needs to be taken to ensure that patients are properly informed about their condition and its treatment, if Chester v Afshar-type claims are to be avoided.

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References

See for example Scott RAP. The place of screening in the management of abdominal aortic aneurysm. Scanda J Surg 2008; 97: 136–8, which suggests a 58% reduction in mortality

Markides

, Subar

, Al-Khaffaf

. Litigation claims in vascular surgery in the United Kingdom's NHS. Eur J Endovasc Surg 2008; 36: 452–7

For example, Markides et al. identified two successful claims relating to AAA surgery. In one claim nerve damage had been caused, the other related to suturing of the bowel wall: ibid. Unsurprisingly, it appears that the lowest mortality and morbidity rates for AAA repair are achieved by specialist vascular surgeons who perform the highest numbers of such repairs in hospitals in which the largets numbers of such operations are conducted: see for example Holt PJ, Poloniecki JD, Loftus IM, Michaels JA, Thompson MM. Epidemiological study of the relationship between volume and outcome after abdominal aortic aneurysm surgery in the UK from 2000 to 2005. Br J Surg 2007; 94: 441–8; Rosenthal R, von Kanel O, Eugster T, Stierli P, Gurke L. Does specialization improve outcome in abdominal aortic anuerysm surgery? Vascular 2005; 13: 107–13

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Berman

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, Fraenkel

. Informed consent for abdominal aortic aneurysm repair: The patient's perspective. J Vasc Surg 2008; 48: 296–302. The study was small-scale (20 patients were interviewed), but nevertheless highlights some significant difficulties in relation to obtaining informed consent to AAA surgery. Cf Vohra HA, Ledsham J, Vohra H, Patel RL. Issues concerning consent in patients undergoing cardiac surgery – the need for patient-directed improvements: a UK perspective. Cardiovasc Surg 2003; 11: 64–9

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Berman et al., ibid. , 298–9

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See Hafez H [ante], 4–5

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Hafez

, above, n26

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A number of organizations provide clear, patient-friendly information about AAAs, including NHS Direct (www.nhsdirect.nhs.uk), the British Heart Foundation (Factfile No. 7, 2008), the Circulation Foundation (www.circulationfoundation.org.uk), www.patient.co.uk and NICE (‘Keyhole surgery to repair abdominal aortic aneurysm’, Information about NICE interventional procedural guidance 229, London: NICE, 2007. See http://www.nice.org.uk/)

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See for example Johnson JN. Should we screen for aortic aneurysm? No. BMJ 2008; 336: 863

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But see for example the Australian case of Battersby v Tottman (1985) 37 SASR 524 where the defence of therapeutic privilege succeeded

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Screening for abdominal aortic aneurysms: some legal implications

Abstract

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