Latest Medical Report 13 May 2009
See below.
My medical treatment is now only a daily tablet of low dose aspirin.
_________________________________________
The recent CT of the abdomen and pelvis (20/3/09) demonstrates that the lesion related to the left iliac arterial and venous system is a pelvic arteriovenous malformation. This is a congenital lesion that given this man's duplicated renal system (left-sided !VC), represents congenital variant in his venous anatomy.
The AVM is an incidental finding. There are real risks related to treating the AVM related to embolisation, both locally including to the sciatic nerve and distally to the peripheral arterial tree. At the moment there appear to be few benefits in treating the AVM. Mr Fry is asymptomatic and there is no evidence of distal embolus or circulatory compromise. The AVM in itself does not represent a problem as a space occupying lesion.
At this stage as the risks of treatment outweigh the potential benefits I believe we should adopt a wait and see approach before we intervene in treating the AVM looking for evidence of local symptoms or distal embolisation.
The second problem for this man is his chronic aortic dissection. This is stable. The only ongoing potential clinical problem would be aneurysmal degeneration of the false lumen. This can be well monitored with yearly imaging. Similarly, yearly imaging would monitor the AVM. As such a yearly angio CT looking at both the abdominal aorta and the left-sided pelvic AVM would be reasonable. I have given Mr Fry a form for his next imaging.
The only other issue for this man is the resolving DVT in his left leg. As I have mentioned in my previous letter, given the fact that the thrombus has essentially resolved and the d.dima level is normal, it would be reasonable for this man to manage his venous thromboembolism risk with long term low dose Aspirin rather than Warfarin therapy. Mr Fry has a pair of surgical compression stockings. At this stage he should wear these for symptomatic relief. From my point of view I look forward to seeing this man again in one year.
DAVID HARDMAN
My medical treatment is now only a daily tablet of low dose aspirin.
_________________________________________
The recent CT of the abdomen and pelvis (20/3/09) demonstrates that the lesion related to the left iliac arterial and venous system is a pelvic arteriovenous malformation. This is a congenital lesion that given this man's duplicated renal system (left-sided !VC), represents congenital variant in his venous anatomy.
The AVM is an incidental finding. There are real risks related to treating the AVM related to embolisation, both locally including to the sciatic nerve and distally to the peripheral arterial tree. At the moment there appear to be few benefits in treating the AVM. Mr Fry is asymptomatic and there is no evidence of distal embolus or circulatory compromise. The AVM in itself does not represent a problem as a space occupying lesion.
At this stage as the risks of treatment outweigh the potential benefits I believe we should adopt a wait and see approach before we intervene in treating the AVM looking for evidence of local symptoms or distal embolisation.
The second problem for this man is his chronic aortic dissection. This is stable. The only ongoing potential clinical problem would be aneurysmal degeneration of the false lumen. This can be well monitored with yearly imaging. Similarly, yearly imaging would monitor the AVM. As such a yearly angio CT looking at both the abdominal aorta and the left-sided pelvic AVM would be reasonable. I have given Mr Fry a form for his next imaging.
The only other issue for this man is the resolving DVT in his left leg. As I have mentioned in my previous letter, given the fact that the thrombus has essentially resolved and the d.dima level is normal, it would be reasonable for this man to manage his venous thromboembolism risk with long term low dose Aspirin rather than Warfarin therapy. Mr Fry has a pair of surgical compression stockings. At this stage he should wear these for symptomatic relief. From my point of view I look forward to seeing this man again in one year.
DAVID HARDMAN
posted by Friar at Monday, May 18, 2009
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