Consult – 71-year-old man for consideration of EVAR
- 5.5cm AAA – incidental finding
- Chronic right sided chest/flank pain. CT performed to investigate.
- CKD – Stage 4. Haemodialysis, oliguric, hyperkalaemia and anaemia.
- Currently being considered for renal transplant, AAA repair is a requirement pre-transplant
- IHD – NSTEMI in 2020, admitted with APO
- Angiogram showed 3-vessel disease, for medical management
- Sestamibi – Area of reversible perfusion defect in inferolateral wall.
- Echo – low normal ejection fraction, Mild aortic stenosis
- Paroxysmal AF – Not anticoagulated due to PR bleeding and epistaxis
- Chronic cough – Cryptogenic pneumonia in 2018. Underwent lung biopsy and VATs.
- DASI = 5 MET’s, limited by right-sided pain.
- Recent review by HIPS for right-sided chest pain- concern that patient had significant signs of heart failure and referred to cardiologist
- Patient not seen face-face as anxious to attend due to current coronavirus outbreak
- Cardiac assessment required regarding optimising therapy for IHD and CCF. Important to consider deterioration of aortic stenosis.
- Multiple specialists involved for renal and respiratory. Regular review.
- Renal transplant surgery could be extremely challenging
- NSQIP: 9.7% risk of cardiac complication, 8.7% risk of mortality
- SORT: 2.7% risk of perioperative mortality
- Patient aware of risks and keen to proceed
- Cardiologist review as above
- Liaise with nephrologist regarding current fluid balance
- Review appointment with patient face-face to examine and consolidate discussion of perioperative risk.