Simultaneous Management of Unstable Angina and Renal Colic in Ankylosing Spondylitis

Abstract

Background: Ankylosing spondylitis (AS) is a seronegative inflammatory disease that progressively affects the spine and sacroiliac joints. It can also predispose patients to several other pathologies. Renal stones have been rarely reported in patients with AS. Case Presentation: In this case, we describe a 54 years old gentleman who presented with acute renal colic as well as unstable angina posing a dilemma over the management strategy. We also discuss our management strategy where we carried out simultaneous an-aortic off-pump beating heart CABG as well as retrieval of ureteric stone with a satisfactory outcome. Conclusions: Though AS increases the risk of adverse outcomes after CABG  it is not significantly associated with poorer overall mortality and long-term outcomes. Therefore, patients should not be denied surgical revascularization. Awareness of issues around intubation, choice of conduits, access to the aorta, sternal closure, and mobilization are important for a satisfactory outcome. The aortic OPCAB approach, where possible,  can ameliorate some of these issues, improve outcomes and minimize future reoperation in this challenging subset of patients.