34yo lady, consult for consideration of stent change.

Background

• Complex urological history – multiple previous surgeries. Right PUJ obstruction and dense ureteric stricture. Previous failed laparoscopic pyeloplasty. Ureteric stent in situ since September 2022
• IHD – NSTEMI October 2022. Angiogram showed 2-vessel disease. PCI with DES to culprit LAD lesion. Left Circumflex 80% distal stenosis treated with medical therapy. On DAPT, recommended 12 months duration.
• IDDM – suboptimal glycaemic control, long-standing. Recently self-ceased oral hypoglycaemic agents and insulin. Random BGL today in clinic 23mmol/L.
• Chronic back pain – describes long-standing sciatica-like symptoms but some suspicion for intermittent claudication. GP has referred to neurosurgery.
• Current smoker – 30 pack years. Normal spirometry
• Complex social situation – childhood trauma. Currently undergoing significant stressors with her own children.

Issues

• Timing of procedure after PCI/NSTEMI
• Targets for optimisation

Discussion

• Aboriginal liaison officer possible role
• Timing of surgery – procedure needs to occur due to in situ stent therefore timing to be guided by cardiology and urology teams (ideally would wait 12 mths after AMI but not feasible here).

Plan

• Liaise with urologists regarding clopidogrel plans and timing of surgery
• Physician review for general medical optimisation
• Patient declining social/ALO involvement
• Surgery in a centre with PCI availability