David Gifford · Prevention of Future Deaths report

On 3 December 2024 an investigation was commenced into the death of David Stewart Gifford. The investigation concluded at the end of the inquest on 30 June 2025. The conclusion of the inquest was:

Natural causes

The cause of death was recorded as:

1a Ruptured thoraco-abdominal aortic aneurysm
1b Fractured stent and endoleak
1c Aortic dissection and multiple aortic aneurysms - stented

David Gifford had an extensive medical history with significant co-morbidities. He had a long cardiac history which included aortic dissection, multiple aortic aneurysms and heart failure. He first underwent surgery for aortic dissection in 2006.

He subsequently underwent further surgery on multiple occasions for further stenting and grafting to repair additional ruptures to his aorta. He developed an endoleak which was monitored and remained stable for many years, until it required surgery in 2023.

Mr Gifford died on 26 November 2024 at Southmead Hospital. His death was caused by an acute ruptured abdominal aortic aneurysm, following the development of a fractured stent and endoleak at some point in the weeks preceding his death. It was not clear for exactly how long this endoleak had been present, or when the fracture occurred.

In the weeks before his death, Mr Gifford had had multiple visits to his GP surgery. He was a complex patient with a number of medical condition and he had been experiencing a range of symptoms. The clinicians he saw referred him for further investigations into his symptoms.

In the afternoon of 25 November 2024, Mr Gifford made a 999 call to the ambulance due to right-sided neck pain which radiated down his back and to his flank. He had been experiencing this pain since August 2024. Paramedics attended in the evening, and after an assessment, they did not think he needed to be conveyed to hospital. Worsening advice was given which resulted in Mr Gifford calling 999 again late that evening and an ambulance arrived in the early hours of 26 November 2024. He was conveyed to hospital and then transferred to Southmead Hospital, where he lost cardiac output whilst still on the trolley.

There were concerns raised about recognition of an Abdominal Aortic Aneurysm (AAA), and its rupture. Whilst training and knowledge focuses on identification of any ‘red flag symptoms’, it is well known that a number of AAA’s do not present in this way, resulting in a group of patients who are challenging to diagnose, and who may be missed.

(1) Training and knowledge focuses on the classic signs and symptoms associated with an AAA. However, there are a group of patients who will not present in this way, and who may be challenging to diagnose. Whilst there may be many medical conditions that could be similar, there does not seem to be much focus given to the identification of vascular emergencies within training and knowledge updates. Therefore when paramedics attend emergencies, in the absence of classic symptoms, they may be wrongly reassured. Where a person has an extensive aortic history, the importance of aortic pathology should be considered.

(2) There has not been training or medical education for ambulance on vascular emergencies for a long time. The evidence was that JRCALC guidelines did recently highlight the number of patients that may not present with the traditional ‘red flags’ but did not provide further guidance. This is a national issue where ambulance staff should be knowledgeable about the more subtle signs of vascular emergencies that may be missed.