79-year-old man for consideration of open vs endovascular AAA repair. 

Background:

• 5.1cm infra-renal AAA
• OA knee – awaiting TKR
• Previously discussed at PIG meeting

Issues

• Desaturated significantly during CPET test: 96-84%. Asymptomatic
• Limited by knee pain, no dyspnoea. 
• Spirometry – restrictive ventilatory defect. FEV1=2.28 (75%), FVC= 2.72 (67%)
• CXR – bilateral pulmonary infiltrates
• CT chest showed fibrosing interstitial lung disease – new diagnosis

Discussion

Suitability for open procedure?

• Awaiting respiratory review but consensus that this patient is optimised
• Endovascular approach would be preferable
• Open AAA repair reasonable in with effective regional analgesia and postoperative care

Post-operative Disposition

• ICU 2 for open procedure

Plan

• As above, await respiratory consult and surgical plan.