65yo male with a thoracic aortic 5.5cm descending aneurysm, endograft (fenestration for left subclavian) with rapid pacing.

Background:

• IHD
• HTN
• Recent ex-smoker
• OSA
• CKD
• 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

Issues

• ? 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.

Plan

• Ongoing immunotherapy
• Revisit in 3 months