89yo lady for lower leg angiogram and popliteal recanalisation for non-healing ulcers.

Background:

• IHD – recent NSTEMI, diagnosed after prompted to see GP by clinic doctor for SOB during phone consult. 3VD. For medical mx.
• PVD – Ulcer now mostly healed while awaiting surgical mx.
• CCF – recent admission with decompensation. TTE shows severe global dysfx due to DCM, EF 20-25%. Not thought solely due to IHD (but other contributors unknown)
• CKD – eGFR 35 (likely over-estimation given her low weight)
• Ex tolerance – vacuums, shops, 1 FOS ok

Discussion

• Proceed with lower limb angiography/plasty?
  • Able to lie flat
  • Nothing beyond local anaesthetic needed
  • Risk of presenting for emergency procedure (e.g., partial lower limb amputations) if this low-physiologic stress, low risk procedure is avoided.

• Optimisable?
  • For further discussions with cardiologist given severity of CCF and recent decompensation

Plan

• Discuss with cardiologist as above
• Proceed