Severe DCM, endovasular recanalisation

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


  • 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


  • 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


  • Discuss with cardiologist as above
  • Proceed