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Heart Disease (Expert Forum)
54 y/o dad w/3 blockages, renal blockage, aortic aneurysm - facing decision
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54 y/o dad w/3 blockages, renal blockage, aortic aneurysm - facing decision
by cardiogirl, May 21, 2004 12:00AM
Thank you for taking my questions.
This post is for my father. 54, smoker, current cholesterol 385 & triglyc 350. Four bypasses 1997. Family history early onset CAD. False-negatives on stress tests. Handful of meds for CAD & Chrons. Cath on 5/19 revealed 3 new blockages; 80, 80, 90%. He also has an aortic aneurysm (new) and something about renal artery blockage (new). Primary symptom is transient shortness of breath that I’d consider severe.
He must choose 3 stents or bypass surgery. His first bypass surgery was emergency because the stent perforated his artery due to weakening from years of Prednisone therapy for Chrons Disease. Needless to say, this is a tough call.
Q1: Can you explain what the aortic aneurysm and renal artery blockage are, what they mean to the general prognosis and what they say of the CAD progression?
Q2: What are the risks of a second bypass surgery versus stenting weakened vessels? In your *personal opinion*, which route would you go with a patient with his history?
Q3: They plan to insert the 3 stents and 3 different times. Why on earth wouldn’t they do all of them at once?
Q4: I’ve heard that grafts last 12 years under good circumstances, much less in smokers. With such severe occlusion and high lipids, what sort of prognosis are we looking at?
I wish desperately that he could go to CCF, but his insurance won’t allow.
Bless you doctors for the generous donation of your time to this wonderful forum.
This post is for my father. 54, smoker, current cholesterol 385 & triglyc 350. Four bypasses 1997. Family history early onset CAD. False-negatives on stress tests. Handful of meds for CAD & Chrons. Cath on 5/19 revealed 3 new blockages; 80, 80, 90%. He also has an aortic aneurysm (new) and something about renal artery blockage (new). Primary symptom is transient shortness of breath that I’d consider severe.
He must choose 3 stents or bypass surgery. His first bypass surgery was emergency because the stent perforated his artery due to weakening from years of Prednisone therapy for Chrons Disease. Needless to say, this is a tough call.
Q1: Can you explain what the aortic aneurysm and renal artery blockage are, what they mean to the general prognosis and what they say of the CAD progression?
Q2: What are the risks of a second bypass surgery versus stenting weakened vessels? In your *personal opinion*, which route would you go with a patient with his history?
Q3: They plan to insert the 3 stents and 3 different times. Why on earth wouldn’t they do all of them at once?
Q4: I’ve heard that grafts last 12 years under good circumstances, much less in smokers. With such severe occlusion and high lipids, what sort of prognosis are we looking at?
I wish desperately that he could go to CCF, but his insurance won’t allow.
Bless you doctors for the generous donation of your time to this wonderful forum.
Doctor's Answer
by CCF-M.D.-RCJ, May 22, 2004 12:00AM
cardiogirl,
Thanks for the post.
"Q1: Can you explain what the aortic aneurysm and renal artery blockage are, what they mean to the general prognosis and what they say of the CAD progression?"
An aortic aneurysm is an expansion of the size of the aorta in a particular area. It is a manifestation of vascular disease, as is CAD, and renal artery stenosis. Renal artery stenosis is a blockage in an artery going to a kidney, and can cause transient shortness of breath just like CAD.
"Q2: What are the risks of a second bypass surgery versus stenting weakened vessels? In your *personal opinion*, which route would you go with a patient with his history?"
I can't know the answer to this without seeing him in person. If I knew, I would tell you, but honestly, this question is impossible to answer over the internet.
"Q3: They plan to insert the 3 stents and 3 different times. Why on earth wouldn’t they do all of them at once?"
Could be one of several different reasons. One is that the likelihood of something bad happening goes up as you stent more vessels. Billing may also be an issue.
"Q4: I’ve heard that grafts last 12 years under good circumstances, much less in smokers. With such severe occlusion and high lipids, what sort of prognosis are we looking at?"
On a statistical basis, much less than 12 years. Performing surgery or stenting makes absolutely no sense if it is not done in connection with expert and aggressive lipid management. You wouldn't repair pipes in your house if you were still flushing them with acid.
Best of luck.
Thanks for the post.
"Q1: Can you explain what the aortic aneurysm and renal artery blockage are, what they mean to the general prognosis and what they say of the CAD progression?"
An aortic aneurysm is an expansion of the size of the aorta in a particular area. It is a manifestation of vascular disease, as is CAD, and renal artery stenosis. Renal artery stenosis is a blockage in an artery going to a kidney, and can cause transient shortness of breath just like CAD.
"Q2: What are the risks of a second bypass surgery versus stenting weakened vessels? In your *personal opinion*, which route would you go with a patient with his history?"
I can't know the answer to this without seeing him in person. If I knew, I would tell you, but honestly, this question is impossible to answer over the internet.
"Q3: They plan to insert the 3 stents and 3 different times. Why on earth wouldn’t they do all of them at once?"
Could be one of several different reasons. One is that the likelihood of something bad happening goes up as you stent more vessels. Billing may also be an issue.
"Q4: I’ve heard that grafts last 12 years under good circumstances, much less in smokers. With such severe occlusion and high lipids, what sort of prognosis are we looking at?"
On a statistical basis, much less than 12 years. Performing surgery or stenting makes absolutely no sense if it is not done in connection with expert and aggressive lipid management. You wouldn't repair pipes in your house if you were still flushing them with acid.
Best of luck.
Member Comments (1)
by MEMAW57, May 25, 2008 09:06PM
A related discussion, RENAL BY PASS was started.
