1. Varicose vein surgery: a few medicolegal considerations Jon Ghosh SpR General / Vascular Surgery

2. Friedrich Trendelenburg 1844-1924

3. Superficial Venous Surgery 70000-10000 operations / year At 10 years (REACTIV study: Campbell 2003) –77% symptom free –Only 30% varicosity free –34% patients unsatisfied 30-40 legal actions / year

4. Varicose vein litigation Total number of reported CNST claims by specialty from 1995 General / Vascular surgery claims settled by MDU

5. Varicose vein litigation Total number of reported CNST claims by specialty from 1995 General / Vascular surgery claims settled by MDU £5.5 million

6. Claim v complications rates %

7. %

8. Inappropriate surgery/ expectation of surgery * %

9. Reasons for legal action %

10. Grade of primary surgeon - all claims

11. Nerve Injury 30% claims Cutaneous C Peroneal Sural Saphenous

12. Nerve Injury 30% claims Cutaneous C Peroneal Sural Saphenous £15,000-90,000 n/a

13. Nerve Injury 30% claims Cutaneous C Peroneal Sural Saphenous £15,000-90,000 n/a

14. Major vascular injury Femoral vein most common Indefensible: £65000 - 225000 damages

15. Major vascular injury Femoral vein most common Indefensible: £65000 - 225000 damages

16. Major vascular injury Femoral vein most common Indefensible: £65000 - 225000 damages DVT/PE –Indefensible: failure to provide prophylaxis in high risk pt. upto £550,000 damages

17. Observations Senior surgeons Patient selection Avoid hasty pre-op assessment Counseling (esp. after Chester v Ashfar) –Recurrences –Wound problems –Nerve injury risks Impact of endovascular technologies awaited

18. Observations Senior surgeons Patient selection Avoid hasty pre-op assessment Counseling (esp. after Chester v Ashfar) –Recurrences –Wound problems –Nerve injury risks Impact of endovascular technologies awaited

19. Observations Senior surgeons Patient selection Avoid hasty pre-op assessment Counseling (esp. after Chester v Ashfar) –Recurrences –Wound problems –Nerve injury risks Impact of endovascular technologies awaited

20. Observations Senior surgeons Patient selection Avoid hasty pre-op assessment Counseling (esp. after Chester v Ashfar) –Recurrences –Wound problems –Nerve injury risks Impact of endovascular technologies awaited

24. Complications % of all operations