65yo male with a thoracic aortic 5.5cm descending aneurysm, endograft (fenestration for left subclavian) with rapid pacing.
- Recent ex-smoker
- Non-labelled thrombophilia (DVT/PE’s 70s) on Xarelto
- DASI 5.1
- Wegener’s recent diagnosis:
- 3/12 history of increasing SOB (unable to complete 1 FOS) + palpitations
- Cardiologist proceeded straight to angiogram due to high pre-test probability of obstructive CAD. Angiogram was ~ normal.
- Respiratory review – diagnosed with Wegener’s granulomatosis
- High dose prednisone improved his CXR changes/spirometry and an associated pancolitis.
- Now on rituximab monthly
- ? Fit for surgery
- Immunologist says pt will never be cured from his vasculitis.
- Aim is to wean off high dose prednisone
- Surgeon is happy to wait
- Graft may not be ideal with vasculitis.
- Ongoing immunotherapy
- Revisit in 3 months