Patient Dies After Femoral Sheath is Removed by Resident

This case takes place in New Hampshire and involves an elderly male patient who underwent femoral angioplasty. He proceeded to develop abdominal pain 2 hours after the procedure was completed due to an unrecognized peritoneal bleed. The patient was later seen by a resident who had limited experience removing femoral sheaths; yet the resident pulled the patient’s femoral sheath regardless, causing massive hemorrhaging that ultimately resulted in the patients death. The anticoagulant that was used during procedure was Argatroban, and the patient had the same procedure performed on the opposite leg three weeks prior with no complications. The patient’s estate believes that the central issue in this case was that the femoral sheath was pulled by the resident when the patient was having abdominal pain. It is also questionable as to whether or not the patient was hypotensive, and there was no confirmation that the patient was or was not anticoagulated when the sheath was pulled.

Question(s) For Expert Witness

1. What are safety guidelines to consider following a femoral angioplasty - and should residents be supervised while removing a femoral sheath?

2. Is this a known complication or an isolated incident of which a diligent interventional radiologist ought to mindful and able to avoid?

3. Have you ever served as an expert witness on a case similar to the one described?

Expert Witness Response E-007065

Initially, residents require observation and oversight to demonstrate mastery of these skills, including techniques, knowledge of what to ask, monitoring, and post procedure documentation. Then residents are permitted to perform this procedure in an area where immediate assistance is needed. The complication described is not an expected complication. However, it is hard to answer extensively given lack of imaging and knowledge of the procedure.