Understanding the 6 ‘P’s of vascular disease

Sometimes a medic might miss the signs of a serious and catastrophic condition, resulting in the amputation of a limb that may have otherwise been avoided. In the case of limb ischaemia; a sudden lack of blood flow to a limb, usually caused by embolism or thrombosis, a fast diagnosis is crucial – and often means the difference between saving the limb or amputating it.

Here, we outline what to watch out for, when to escalate your concerns, and when an oversight becomes negligent.

What is limb ischaemia?

The main causes of limb ischaemia are usually embolism (cardiac related) or thrombosis (blot clots). What is important to understand, is that this condition is easily treatable with the proper surgical care. But it is crucial to diagnose and treat the condition promptly and usually on the day of onset of symptoms, and a failure to do so can result in permanent disability, amputation or death.

The trouble with limb ischaemia is that the symptoms can mimic other conditions. The condition is often misdiagnosed as sciatica, arterial insufficiency or peripheral vascular disease. It is therefore critical to pay attention to the 6 ‘P’s of limb ischaemia; and patients should not be afraid to ask for a second opinion if they are concerned about the symptoms. Medical professionals do sometimes make mistakes, and the vigilance of both patient and doctor can mean the difference between successful treatment and an amputation that could have been avoided.

The 6 ‘P’s of limb ischaemia are:

• Pallor (pale appearance of the limb)
• Pain
• Paraesthesia (abnormal sensations of the limb)
• Paralysis
• Pulselessness
• Perishing with cold

Why would limb ischaemia be misdiagnosed?

Misdiagnosis of this condition is unfortunately common. Data held by the NHS Litigation Authority (NHSLA), the Medical Defence Union (MDU), and the Medical Protection Society (MPS) confirms 224 cases of acute leg ischaemia, all of which led to limb loss, over a 10-year period.

At Fletchers, we have seen numerous cases over the years, and have gone on to support clients who have suffered an avoidable amputation due to negligent medical observations.
When examining a patient who presents with any of the above symptoms, medics should take into account the medical history as well as the physical presentations, in order to ascertain whether the condition is likely to be embolic or thrombotic.

There are some important features to differentiate the origin of the condition; include rapidity of symptom onset, features of pre-existing chronic arterial disease, potential source of embolus and the pulses in the affected limb.

Misdiagnosis during this critical time can occur particularly if the limb has become red when dependant; often leading to the medic assuming inflammation, gout or cellulitis. However, once the skin has developed fixed mottling, the change is already irreversible.

Acute limb ischaemia misdiagnosis case example

A 55-year-old man visited his GP for persistent pain in his left leg that had been present three days. He also noted a numb feeling in the foot. In terms of medication, he was taking treatment for hypertension, had a history of low back pain, and was a smoker of 20 cigarettes a day. On inspection, the foot looked normal, but sensation seemed mildly reduced. His GP noted a weak dorsalis pedis pulse and diagnosed sciatica. The patient was prescribed diclofenac and he was encouraged to return a week later if no better. Six days later he visited a local emergency department with intolerable pain. He was then found to have a profoundly ischaemic left leg, requiring an above knee amputation.

Source: bmj.com

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What patients and medical professionals should be aware of

It is imperative that patients and medical professionals are vigilant when it comes to assessing and correctly treating limb ischaemia. Doctors are trained to spot the signs of this condition, and have a duty of care to act fast when faced with the signs; but there are some things patients can do to help the process too.

1. Be vigilant: Watch for signs of the condition worsening and keep a diary of any changes to help evidence the speed of the process with your GP.

2. Ask for a second opinion. If you are refused – ask again: It is your right to seek a second opinion and a referral to a specialist, particularly if you feel the care you have received is substandard.

3. Understand your own body: Only you know what feels right for your own body. If you are concerned, if something feels off – trust your instincts.

Unfortunately, we have represented many victims of acute limb ischaemia misdiagnosis. Our clients have gone on to experience severe medical complications, sometimes resulting in amputation. If you have been affected and you believe that your amputation could be avoided – we want to help.

Call us now on 0330 013 0251 or start your claim today with our online form.