Background:

• PVD
• CKD
• Nursing home resident, requires assistance with ADL’s
• DASI 2.6 MET’s

Issues:

• Complex IHD
  • CABG x2, all grafts blocked, multiple DES in grafts
  • Daily stable angina
  • Normal LV function with mild RWMA
  • Regular cardiologist review, optimal medical therapy, lifelong plavix
• Haematuria
  • Post IDC insertion in nursing home for urinary retention
  • On Clopidogrel at time
  • Imaging showed bilateral hydronephrosis and enlarged prostate

Discussion:

• High-risk for perioperative MACE
  • Bleeding risk
  • On optimal therapy
  • Will require cessation of antiplatelet agent perioperatively
• TURP
  • Longer procedure
  • Also consented for SPC – is this long or short-term?
  • TURP requires significant period of antiplatelet cessation
• Surgical discussion
  • Patient can have just the SPC as a permanent solution under LA, TURP may or may not render him catheter-free
  • Either option will require cessation of antiplatelets but much shorter duration for SPC
  • Final option would be to wait and see, patient will always need an IDC but if he is stable and happy with current situation then continue IDC changes in nursing home and organize surgical review in 6 months
• Patient discussion – the above discussed with patient and nurse, opted to continue with IDC and review in 6 months
  • Currently no issues with the IDC
  • Patient concerned about cardiac comorbidities

Plan:

• IDC to remain in situ
• Urology outpatient review in 6 months