60+ patient, infrarenal AAA

Background

• Asthma COPD
• Smoker
• HTN
• Inferior MI in 30s
• Exercise tolerance – DASI METS = 9, CPET/PFTs – DLCO near normal, FEV1 65% (reversible with bronchodilators), AT 13ml/kg/min, VO2peak 19ml/kg/min, VE/VCO2 36 (borderline elevated)
• Itinerant
• ETOH misuse/abuse

Issues

• Open vs endoluminal?
• Elevated fasting BGL – awaiting OGTT
• Bronchodilator responsiveness on PFTs – Symbicort commenced

Discussion

• Open procedure appropriate from risk perspective
• Without exacerbations of COPD, the addition of ICS to regular regime may increase M&M from pneumonia – suggest LABA/LAMA instead (see https://goldcopd.org/wp-content/uploads/2020/03/GOLD-2020-POCKET-GUIDE-ver1.0_FINAL-WMV.pdf)
• HbA1c is a reliable method of diagnose DM without the need for fasting or glucose tolerance testing

Plan

• Proceed
• ETOH reduction
• DM optimization preop if further testing reveals DM