Wegener’s granulomatosis, TEVAR

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


  • 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


  • ? 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