Lower Limb Ischaemia Explained
Limb ischaemia must be diagnosed and treated without delay, or the leg may become so damaged that an amputation is necessary.
If medical professionals fail to manage limb ischaemia in an acceptable fashion, resulting in complications, there may be grounds for a medical negligence compensation claim.
To find out more, you need to speak to a medical negligence solicitor as soon as possible.
What is lower limb ischaemia?
Ischaemia is when the blood supply to an area of the body is restricted, causing a shortage of oxygen. This leads to the build-up of waste products and a deficiency in oxygen, damaging the surrounding tissue, muscles and nerves.
Lower limb ischaemia is when the blood supply to the legs is reduced. It is a condition that affects around 12,000 patients in the UK every year. It happens when the arteries in the legs become blocked. Ordinarily this is caused by lower limb arterial disease such as atheroma.
Atheroma is when fatty deposits develop in the lining of the arteries, hardening the arteries and restricting the flow of blood. In around 90% of cases, atheroma is caused by smoking. Other causes include diabetes, high blood pressure and high cholesterol.
Atheroma and intermittent claudication
Atheroma can narrow the arteries to such an extent that chronic (gradual) lower limb ischaemia arises. This will cause a symptom known as intermittent claudication. This is when the arteries cannot provide enough blood flow to power the muscles.
Intermittent claudication may not cause any problems while sitting, but can result in an aching pain upon exercise – for example, while walking or running. There may also be pain during the night, which is usually relieved by hanging the affected leg out of the bed.
A patient with these symptoms should be advised upon how best to restore blood flow to the leg. This can normally be achieved with non-invasive measures such as smoking cessation, high blood pressure management, cholesterol management and exercise.
Chronic lower limb ischaemia complications
Chronic lower limb ischaemia will not lead to serious complications, as long as it is treated appropriately.
If left untreated for too long, it is possible that the arteries will continue to narrow until severe ischaemia occurs. This will damage the skin, leading to an ulcer on the leg or foot that cannot be healed. If a patient progresses to this stage, he/she is said to have critical ischaemia.
Critical ischaemia requires urgent surgical intervention in order to restore blood supply to the limb. Treatment may be delayed for a few days, but if surgery is not performed within weeks or months, the damage will be irreparable.
If critical ischaemia is not treated in time, a patient will need an amputation.
Acute lower limb ischaemia complications
Chronic lower limb ischaemia develops very gradually. On the other hand, acute lower limb ischaemia will arise very quickly.
Acute lower limb ischaemia happens when an event suddenly blocks an artery in the leg. For example, a clot may develop in an artery affected by atheroma. Or a clot may travel from elsewhere in the body, getting stuck in the leg. This is called an embolism.
Acute lower limb ischaemia is associated with a number of symptoms, including:-
- Severe pain in the leg
- A limb that is cold and pale
- Reduced sensation/numbness in the leg
- Paralysis
- Loss of peripheral pulse
Acute lower limb ischaemia is a medical emergency. This is because the surrounding skin, muscles and nerves will become irretrievably damaged within six to eight hours of the onset of symptoms. If surgical intervention is not provided within this window of opportunity, the limb will be so damaged that an amputation is required.
Preventing amputation because of lower limb ischaemia
The only way to prevent an amputation is to diagnose and treat lower limb ischaemia
Acute lower limb ischaemia is characterised by very sudden and very severe symptoms. Frequently this prompts a patient to seek attention from the nearest Accident & Emergency department. Medical practitioners within the hospital should be able to recognise the symptoms of acute lower limb ischaemia immediately and provide emergency surgical treatment.
It is unusual for there to be a delay in treatment. However, if there is an unnecessary delay in the provision of emergency surgery – perhaps due to a missed diagnosis – the level of care will be considered substandard.
Chronic lower limb ischaemia is characterised by intermittent claudication, and this should provoke a medical practitioner to investigate the possibility of arterial diseases such as atheroma. This is especially important if a patient is showing signs of critical ischaemia, such as leg pain during the night or at rest.
Critical limb ischaemia can be diagnosed by assessing peripheral pulses. This can be done by hand, although some ankle pulses can be difficult to feel. A more reliable tool is a Doppler ultrasound probe. If there is an absent pulse, a medical practitioner can be sure that blood is not flowing to that area of the leg.
Once diagnosed, critical limb ischaemia will need surgical intervention to restore blood flow to the limb. In cases of critical limb ischaemia where the correct treatment has been provided, 90% of limbs have been successfully treated.
If a medical practitioner fails to assess a patient's ankle pulses, despite the fact he/she is showing signs of critical ischaemia, the level of care will be considered substandard.
Failure to diagnose lower limb ischaemia
If medical professionals fail to diagnose lower limb ischaemia, even though a patient has the clinical signs of the condition, there will be a substandard level of care. If this causes a patient to develop complications – such as an amputation or chronic leg ulcers – there will be grounds for a medical negligence compensation claim.
A medical negligence claim may arise because of lower limb ischaemia for the following reasons:-
- A failure to diagnose in a timely fashion. This will be six to eight hours for acute lower limb ischaemia and a few days for chronic limb ischaemia
- A failure to check palpitation of ankle pulses when making a diagnosis
- A failure to check a misdiagnosis has not been made. Commonly lower limb ischaemia is mistaken for gout, arthritis and plantar fasciitis
- A failure to provide emergency surgical treatment for acute lower limb ischaemia, and urgent treatment for critical ischaemia
- Failure to prevent chronic leg ulceration and amputation
Acute lower limb ischaemia and critical limb ischaemia require prompt treatment. If this is not achieved by medical professionals because of the reasons outlined above, you must seek expert legal advice.
Consequences of lower limb ischaemia negligence
When lower limb ischaemia is negligently managed, the consequences can be devastating. Indeed, patients who are not diagnosed and treated will suffer damage to the nerves, muscle and tissue. Within a very short space of time, there will not be enough blood to keep the leg alive. Once this happens, the leg cannot be restored and the only option is to amputate the affected area. This may be the toes, foot, lower leg or entire leg.
Even if an amputation is not carried out, the patient will be left with an area of skin that has been irreparably destroyed. This is called a chronic leg ulcer and must be regularly dressed with compression bandages. In some cases, a patient presents with a chronic leg ulcer but the underlying cause of lower limb ischaemia is still not diagnosed. As a result the ulcer is dressed with a compression bandage, cutting off the blood flow even further. This will cause acute ischaemia within hours, and may lead to an amputation. Again, this will be deemed negligent.
Can I make a medical negligence claim?
If you have suffered complications because doctors failed to manage your lower limb ischaemia properly, you need to speak to a solicitor about your options.
A solicitor who specialises in medical negligence claims will be able to listen to the details of your experience before suggesting whether or not you are eligible to pursue litigation. We offer a free initial consultation, so you can discuss your case with a solicitor free of charge.
This initial enquiry will give you the chance to discover whether you have been the victim of medical negligence. However, you will not have to pay anything, nor will you be obliged to instruct our services thereafter.
Making a claim for lower limb ischaemia
If you are advised that you have been the innocent victim of medical negligence, you must decide whether or not you would like to pursue a claim.
If so, your solicitor will begin the process on your behalf, and will subsequently handle the entire claim for you. You will need to liaise with your solicitor, and you will need to assist with certain elements of the claims process, such as providing a witness statement and giving details of your financial losses. Nevertheless, your solicitor will guide you through each stage, explaining each step in detail.
Compensation for lower limb ischaemia
If lower limb ischaemia is not managed to an acceptable standard, the effects can be life-changing. This is especially true of anyone who has undergone amputation. For these patients, tasks that were once commonplace will now be extremely difficult to undertake. This includes walking, dressing and driving.
A wrongful amputation will also have a terrible psychological impact, as the patient must come to terms with their disability, all the while knowing that proper medical care could have ensured a better outcome. Knowing that an amputation could have been avoided will be very hard to deal with and often creates feelings of anger and frustration.
Additionally, an amputation can have significant financial implications. The individual in question may no longer be able to work, and may require adaptations around the home.
The compensation awarded for medical negligence is intended to reflect all of these damages, including your physical, emotional and financial suffering. Although this will not turn back the clock, it will provide some form of redress, and will ensure you are financially supported for the remainder of your life.
Will I have to pay any money?
The costs involved in a medical negligence claim is one the primary concerns of potential claimants. Your solicitor will be able to take you through the costs involved.
A brief explanation is that if you have a no win no fee agreement with your solicitor, you will not pay anything should you lose your claim. If you win your claim, you may need to contribute towards your solicitor's fees. This is taken straight out of your compensation settlement, although it is capped at 25% of your damages. So if you are awarded £20,000 compensation, you may have to pay up to £5,000 in legal fees.
Are there any time limits involved?
If you suspect you could be entitled to claim medical negligence compensation, you must not delay in speaking to a solicitor. This is because there are time limits at play. Most medical negligence claims must be made within three years of the negligent incident. You may be able to rely on a later date of knowledge if the negligence was not immediately obvious to you.
There are some exceptions to this three year rule. If the claimant was under the age of 18 when the negligence occurred, he/she will have until their 21st birthday to bring a claim. If the claimant lacks mental capacity, there will not be a time limit.
Otherwise, if you miss the three year limitation date, you will not be able to bring a claim - even if you have a very strong case. This means it is very important not to hesitate when contacting a solicitor.
Speak to a specialist solicitor today
At Glynns Solicitors we specialise in medical negligence claims and can provide you with expert legal advice. We will use our knowledge and expertise to suggest whether or not you are able to make a claim for a complications arising due to lower limb ischaemia, such as a wrongful amputation. For more information, please call us free on 0800 234 3300 (or from a mobile 01275 334030) or complete our Online Enquiry Form.
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