EVAR and ? carcinoid

84yo male with 5cm AAA for EVAR


  • Nil CVS/RS dx
  • Essential tremor
  • MOCA 24/30
  • Fungal sinusitis


? Carcinoid

  • Recent hospitalization with severe pruritic rash, postural dizziness, flushing. Suggestion of carcinoid syndrome but no testing undertaken.
  • Vascular surgeons happy to defer surgery given AAA 5cm, nil overly concerning imaging findings and asymptomatic
  • Panel of biomarkers arranged
    • Serotonin, glucagon, VIP, urinary 5HIA, chromogranin A
    • Chromogranin A elevated (320) however PPIs and H2 antagonists can lead to elevations
    • Endocrinologists queried mastocytosis, however tryptase level was normal
  • Endocrinologists said that the flush did not sound like a carcinoid flush and were confident that this did NOT represent carcinoid syndrome
  • Rash biopsied (non-specific), commenced on an IL inhibitor for the rash. This medication (like many new monoclonal therapies) does not have an associated infection risk and does not need to be withheld perioperatively.


  • Proceed with the EVAR