Q. Is stent procedure recommended for severe atherosclerosis in 92-year-old patient?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on May 03, 2020

Hello doctor,

My mom is a 92 years old with congestive heart failure.

CT scan showed extensive atherosclerosis of the aorta. Probable high-grade stenosis of the right common iliac artery and the bilateral common femoral artery. She also has kidney disease in the left kidney and extreme fatigue for two years.

Would she be a candidate for a stent or some other procedure to unblock the artery? And could this condition be causing her fatigue? None of her doctors can figure out the reason for fatigue. Please help.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome to icliniq.com.

This is a non-contrast CT (computed tomography) so it is not accurate in estimating the extent of stenosis. (attachment removed to protect patient identity).

She will need a contrast CT angiography of abdominal vessels. However, the common iliac artery and femoral arteries are usually amenable to stenting, unless CT angiography shows diffuse disease (whole of the artery is involved with no normal segment) where stenting would be difficult. However, a disease involving these arteries is unlikely to cause generalized fatigue, but it can cause pain or weakness in the lower limbs while walking.

Regarding the cause for fatigue, I guess the common causes like low hemoglobin, BP issues, any medications, deranged kidney function, low Vitamin D, deranged blood sugar are ruled out. One important cause that should be ruled out in her is the cardiac cause, because her CT scan shows mild fluid in bilateral lungs which may be related to heart and also with such extensive aortic disease, cardiac arteries are also expected to be involved.

Cardiac disease may cause fatigue, shortness of breath on exertion. So, she should undergo ECG (electrocardiography), echo, and also CT angiography of heart vessels, if possible along with CT angiography of abdominal vessels.

Also, some routine tests like hemogram, LFT (liver function test), RFT (renal function test), vitamin D, thyroid profile, sugar, lipid profile, ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) should also be performed if not done recently.

I hope this helps.


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