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Case Presentation: Aortic Graph Leak Kristina Addie, MS3 Vascular Surgery August 9, 2015 81 y.o. White Male followed by Dr. Kumar Pillai CC: AAA rupture from EVAR in 2012 HPI: Patient was a transfer from Mon General for ruptured AAA. He had EVAR procedure December 13, 2012 completed by Dr. Kumar Pillai. In April of this year he was noted to have an endoleak. He presented at Mon General with abdominal pain and upon CT scan was shown to have developed an retroperitoneal hematoma. He was then transferred here directly to the OR for emergent operation performed by Dr. Alexandre D’Audiffret. PMH: - HTN - Myocardial infarctions: 1976 and 1993 - CAD - Dysrhythmia, ablation in 2003 - AAA Aneurysm first noted in 2000 - DM type 2 Family Hx: - mother: deceased 69- Stroke , emphysema - Brother: MI , alive and well - Son: Diabetes, HTN Social Hx: Tobacco: 25 pack years, quit 11/28/1975 No ETOH use Medications: Aspirin 81 mg Delayed Release (E.C.) PO, 1 qd B complex vitamins PO , 1 qd CALCIUM CARBONATE/VITAMIN D2 (CALCIUM 500 WITH VITAMIN D ) PO CALCIUM CARBONATE/VITAMIN D3 (CALCIUM 600 + D) PO 1 qd Carvedilol (COREG) 6.25 mg Tab , 2 tabs bid Clopidogrel (PLAVIX) 75 mg PO, ½ tab qd COQ10 SG 100, PO qd CRESTOR, PO 20 mg qd Dofetilide (TIKOSYN) 250 mcg PO bid Ferrous sulfate (FERATAB) 324 mg (65 mg iron), Delayed Release (E.C.) PO qd before breakfast LANTUS SC 30 Units SQ Every evening LASIX, PO 80 mg qd LEVOTHROID , PO 75 mcg QD Loratadine (CLARITIN) 10 mg PO qd MULTIVITAMIN W-MINERALS/LUTEIN (CENTRUM SILVER ) PO Nitroglycerin (NITROSTAT) 0.4 mg Sublingual – Every 5 minutes PRN for 3 doses over 15 minutes NOVOLOG SUBQ -10 Units Subcutaneous route TID before meals. Omega-3 Fatty Acids-Vitamin E (FISH OIL) 1,000 mg PO Valsartan (DIOVAN) 160 mg Tab , ½ tab qd Zinc 50 mg Oral Capsule - PO Every Monday, Tuesday, Thursday and Saturday Evaluation: • CT Scan (Abdomen and Pelvis) from Mon General 8/7/15 • CT Angio Abdomen and Pelvis from 4/21/15