Need Interventional Nephrologist.
PC is a 56-year-old gentleman who has been on MWF dialysis since May of 2021. He was having ongoing issues with thrombosis in his AV graft/fistula for many months with multiple declotting procedures. PC wanted to go to the ER for procedure to remove thrombosis from
access once again, however was told by his nephrologist they could do it in the office. PC had outpatient angioplasty of AV graft in nephrologist’s IR suite. PC states procedure was “very
painful”. That operative note states pre-balloon 90% stenosis, post ballooning had 10% residual stenosis. Nephrologist States used a 10mmx40mm compliant balloon during procedure. Photos of angioplasty and angiogram are attached. He notates normal inflow with retrograde angiogram and good thrill on examination post suture.
5 days later PC states unable to lift left arm, has swelling and extreme pain and returns to emergency room. PC goes to vascular surgery for left axillary artery exploration. Upon initial incision to the axilla, large gush of atrial blood was controlled, then found to have substantial hematoma, severe inflammation and large partial dehiscence of axillary artery to graft anastomosis. In addition, the OP note mentions the nerve structures are intact but noted trauma and manipulation. Surgeon removed old graft and replaced with ARTEGRAFT without any complication.
PC required to have stitching, wound vac, extended hospitalization. PC eventually had Permcath placed, however later resorted to having a looped AV graft placed in the left thigh.
Concern is that the original nephrologist caused significant damage with the original angioplasty procedure.
Need Interventional Nephrologist who performs these procedures regularly.
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Do you believe there might have been medical error?
It's not completely clear from the images provided, but there may be an extravasation (damage to the vessel causing blood to leak out of the vessel) causing a hematoma at the site of the balloon. This is a known complication, but should be found and addressed during the procedure. Typically an extravasation is treated by a prolonged inflation of the angioplasty balloon at the site, or a stent.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
If there is clear evidence of an extravasation that was not addressed in the procedure, it caused the hematoma that resulted in the hospitalization and follow up surgery.
What makes you a good expert for this case?
I am a full time practicing nephrologist, board certified. I have been preforming interventional nephrology procedures like the one in this case since I completed fellowship in 2012. I am the president of my nephrology practice with over 40 providers. I have performed over 5,000 interventional nephrology procedures. I have a Florida MD Expert Witness Certificate. I started doing expert witness work 10 months ago. I have not been deposed, but have participated in about 15 cases between plaintiff and defense.
How often do you encounter cases similar to this one in your practice?
I perform over 500 interventional cases per year.
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