A VASCULAR patient who died at Ysbyty Glan Clwyd, Bodelwyddan “would not have died when he did” had he underwent a different operation to treat his aneurysms, an inquest heard.

Alan George, a Liverpool-born retired electrician from Holywell, died at the hospital aged 79 on December 15, 2020.

Following a full inquest into his death, held in Ruthin yesterday (January 25), John Gittins, senior coroner for North Wales East and Central, recorded a narrative conclusion.

Mr George’s medical cause of death was noted as aspiration pneumonia, contributed to by open repair abdominal aortic aneurysm (AAA – swelling of the aorta) and acute kidney injury.

The death of Mr George is one of four at Glan Clwyd being investigated by way of inquest regarding patients who were treated at the hospital for vascular matters.

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During the inquest, Mr George’s son, Christopher, said his father suffered from no medical conditions besides AAA, which was reviewed often.

This aneurysm had grown to such a size where keyhole surgery was no longer option for Mr George, who was told that “more invasive surgery” was needed to remove it.

Mr George was due to have endovascular aneurysm repair (EVAR – a procedure involving a small incision in the groin), but had an open repair (a large incision in the abdomen to expose the aorta) instead.

Aidas Raudonaitis, a vascular surgeon at Glan Clwyd, said that the decision to have Mr George undergo an open repair was guided somewhat by COVID-19-related delays and restrictions in place at the time.

Professor Peter Holt, professor of vascular surgery at St George’s University of London and a consultant vascular and endovascular surgeon at St George's University Hospitals NHS Foundation Trust, was commissioned by Betsi Cadwaladr University Health Board to investigate the matter.

He concluded that, had endovascular treatment been taken, Mr George likely would not have undergone as long a procedure, nor would he have suffered such blood loss and an ischemic leg.

“In my opinion, on the balance of probabilities, had he undergone EVAR, or Fenestrated Endovascular Aortic Repair (FEVAR), the patient would not have died when he did,” Professor Holt said.

Professor Holt described the decision-making process in Mr George’s case as “poor”, and said Glan Clwyd’s multidisciplinary team responsible for his care “lacked leadership”.

The operative procedure taken was, he said, “justifiable, if not the best choice”.

He added that there was “no explanation” for why which Mr George’s procedure took as long as it did, and that a lengthy procedure can be “detrimental to patients’ post-operative course”.

In early 2022, the Royal College of Surgeons published a report relating to vascular surgery, in which Mr George’s case was highlighted.

This ultimately led to a meeting in March 2022 between Glan Clwyd representatives and Mr George’s sons, who said they came away from this “unsatisfied”, feeling they had “questions not fully answered”.

When Mr George was admitted to Glan Clwyd on November 19, 2020 for the operation, staff found four more aneurysms in him; he signed a consent form for the operation knowing about these.

Dr Gareth Mula, consultant anaesthetist, said that, despite him presenting as being in “overall good health” on November 19, he became less stable from about 5pm that day onwards.

Mr George lost roughly 2.5 litres of blood from then on, he said, adding: “It was very difficult to keep Mr George stable… it was clear that he was extremely unwell.”

He transferred Mr George to intensive care at 9.30pm that night, and after he endured a “stormy post-operative period”, he was discharged to a hospital ward on December 8.

Palliative care staff then treated Mr George prior to his death at 5.40pm on December 15.

Concluding, Mr Gittins said it was clear that Mr George had underwent “complex and lengthy” surgery, from which he made a “poor recovery”.

Mr Gittins said a conclusion of death arising from natural causes would not be appropriate given Mr George’s surgery was “perhaps the catalyst (for his death), in terms of his inability to recover fully”.

He added that no Prevention of Future Deaths Report would be issued in this case, saying that the health board appeared to be “on the right track” in addressing these issues.