Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: lisinopril / cozaar / losartan potassium attending: chief complaint: descending aortic ulcer major surgical or invasive procedure: descending aortic ulcer s/p tag history of present illness: 74m w/ pvd s/p aorto-bifem by in ', esrd on hd, about a week ago during dialysis mentioned that he had been having some chest and back pain, not too severe that comes and goes. in they got a ct scan to r/o any acute pathology and found a descending aortic ulcer, 18mm, around t10-t11. was sent into to (their referring center) for further bp and surgical management, then tx here to because is a patient of dr. currently feels well without any complaints. denies any n/v/f/c/d/c/sp or ba pain currently. past medical history: diastolic chf (normal lvef on tte in ) moderate mitral regurgitation copd pvd l renal artery stenosis chronic kidney disease (baseline creatinine ) anemia of chronic kidney disease hx h.pylori infection hx of cellulitis gout colonic polyps h/o herpes zoster claudication carotid stenosis social history: lives in alone, has meals delivered. quit smoking 3 months ago, used to smoke +1ppd x 50 yrs, no etoh x many years, no drugs. family history: non-contributory physical exam: t: 99,3 p: 76 bp: 118/42 rr: 13 spo2 93% gen: nad neuro: alert and oriented x 3 resp: cta b/l cv: rrr abd: soft, nt, nd pulses: palpable through-out left av fistual +thrill/bruit pertinent results: 05:25am blood wbc-22.5* rbc-3.11* hgb-10.8* hct-31.4* mcv-101* mch-34.7* mchc-34.4 rdw-15.6* plt ct-421 05:25am blood plt ct-421 05:25am blood glucose-103 urean-53* creat-6.6*# na-133 k-4.4 cl-91* hco3-28 angap-18 05:25am blood calcium-8.5 phos-4.9* mg-1.8 01:41am blood caltibc-185* ferritn-945* trf-142* name: , unit no: service: date: date of birth: sex: m surgeon: co-surgeons: drs. and . assistants: drs. and . preoperative diagnoses: 1. symptomatic descending thoracic aortic penetrating ulcer. 2. hypertension. 3. chronic renal failure on hemodialysis. 4. peripheral vascular disease status post an aortobifemoral bypass graft by dr. . procedures: 1. repair of descending thoracic aortic penetrating ulcer with tag endo graft 34 x 100 mm. the graft data is the following; catalog number , lot number . 2. thoracic aortography. 3. repair of aortobifemoral bypass graft. the patient is a 77-year-old gentleman with history of back pain and thoracic ct scan showed a penetrating atherosclerotic ulcer with no associated intramural hematoma. the patient had continued back pain despite good medical management of his hypertension. the patient was referred to dr. for consideration of repair. after evaluating the patient, dr. asked me to consider a combined approach for an endo graft repair of the descending thoracic aortic pathology. the patient understood the risks, benefits and possible alternatives including but not limited to bleeding, infection, myocardial infarction, stroke, death, renal and pulmonary insufficiency as well as the possibility of paraplegia and blood transfusion and future operations on his aorta and agreed to proceed. all questions were answered to his satisfaction prior to proceeding with the surgery. operative findings: thoracic aortography in a cross-table lateral position showed that there was a fairly large penetrating ulcer in the mid descending thoracic aorta. thoracic aortography performed after deployment of the stent graft showed that there was initially a type 1 endo leak, but after additional balloon profiling a repeat thoracic aortography showed that there was no type 1 endo leak and good positioning of the prosthesis and no filling of the penetrating ulcer. description of procedure in detail: after informed consent was obtained, the patient brought in the operating room and placed in supine position. general endotracheal tube anesthesia was achieved without difficulty as well as full hemodynamic monitoring. the patient's abdomen, chest and groins, and upper legs were prepped and draped in the usual sterile fashion. a 9-french left femoral venous sheath was placed for anesthesia due to the inability to place a line in the neck. once this was done the right femoral dissection was performed exposing the native circulation (common femoral artery) as well as the right limb of the aortobifemoral both proximally and distally. proximal and distal control was obtained of the graft in the right groin. the left femoral artery was then accessed using a micropuncture technique and a 5-french sheath was placed in the left limb of the aortobifemoral and a pigtail catheter advanced over wire into the descending thoracic aorta under fluoroscopic guidance. an 8-french sheath was then inserted after heparinizing the patient with 5000 units of heparin into the right limb of the aortobifemoral. wire was then advanced into the descending thoracic aorta, kumpe catheter was exchanged over the wire and a stiff lunderquist wire was then placed over the kumpe catheter into the proximal descending thoracic aorta. the kumpe catheter was withdrawn and serial dilators were then used to dilate the right limb of the aortobifemoral up to a 24-french dilator. initially we had planned to use a 37 x 100 mm tag device, however, the 24-french sheath that was necessary to deliver this would not advance into the right limb of the aortobifemoral graft and therefore, we chose to use a 34 x 100 mm graft and the 22-french sheath was then advanced over the lunderquist wire into the right limb of the aortobifemoral bypass graft. once this was done the 34 x 10 tag device was then advanced over the lunderquist wire with some difficulty, but ultimately passed fairly smoothly. the tag device was positioned in the descending thoracic aorta and aortography was then performed in the cross-table lateral orientation to observe the posteriorly directed penetrating ulcer. once the ulcer was identified the tag device was then positioned so that the ulcer was in the middle of the device. we then deployed the tag graft and profile ballooned the device with balloon. once this was done, repeat thoracic aortography was performed which showed a type 1 endo leak from the proximal seal zone, we therefore profile ballooned the proximal landing zone several times and repeated the thoracic aortography which revealed that there was no evidence of an endo leak at this time. all catheters and sheaths were then removed from the right limb of the aortobifemoral graft and the graft was then closed with a running 5-0 prolene stitch. the left-sided femoral sheath was then removed. the patient was then taken to the cardiothoracic surgical intensive care unit in stable condition. dr. and dr. were co-surgeon's on this case due to the complex nature of the disease process. the new technology of stent grafting requires two separate but equally important skill sets of both the cardiothoracic surgeon and vascular surgeon to safely facilitate deployment of these grafts. brief hospital course: transferred from osh for descending aortic ulcer. bp stable. repeat ct scan done on transfer. nephrology consulted for esrd on hd. vitals, bp stable. cta showed aortic ulcer. underwent hd. pre-op'ed for an endovascular repair. vss. cardiac surgery consulted, recommended echo and pre-op cardiac clearance. pt continued on hd mwf. renal following vitals stable. no acute events. or scheduled for tuesday . close monitoring for bp control pre-op'ed for endovascular repair of thoracic aneurysm. pain management for left flank pain. hd today. no acute events. to or (see attached op report). tolerated procedure well without complications. transfer to icu on nitro gtt. vitals table. neo weaned. lopressor po started. transferred to vicu. lumbar drain intact. left groin site stable without hematoma or bleed. stable on floor status. cleared by physical therapy. oob ambulating. dispo planning. dc home without need for vna services. medications on admission: norvasc 10; hydralazine 25'"; asa 81, allopurinol 100', atorvastatin 20, imdur 30', iron 325', folic acid, (recently on prednisone 20' for gout flare) discharge medications: 1. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 2. hydralazine 25 mg tablet sig: one (1) tablet po q8h (every 8 hours). 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 4. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 6. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 8. methylprednisolone 2 mg tablet sig: one (1) tablet po once () for 1 doses: take 6mg (three tablets) on , take 4mg (2 tablets) on , take 2mg (1tablet) on take 1mg ( a tablet). then stop . disp:*8 tablet(s)* refills:*0* 9. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. disp:*30 tablet(s)* refills:*0* 10. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 11. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 12. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals): take as needed at home . 13. famotidine 20 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: hx: cardiomyopathy (transient ef now normal 60%) hypertension crf on hd gout discharge condition: stable discharge instructions: division of vascular and endovascular surgery endovascular thoracic aneurysm repair discharge instructions medications: ?????? take aspirin 81mg once daily ?????? do not stop aspirin unless your vascular surgeon instructs you to do so. ?????? continue all other medications you were taking before surgery, unless otherwise directed ?????? you make take tylenol or prescribed pain medications for any post procedure pain or discomfort what to expect when you go home: it is normal to have slight swelling of the legs: ?????? elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated it is normal to feel tired and have a decreased appetite, your appetite will return with time ?????? drink plenty of fluids and eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? when you go home, you may walk and go up and down stairs ?????? you may shower (let the soapy water run over groin incision, rinse and pat dry) ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed ?????? no heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal) ?????? after 1 week, you may resume sexual activity ?????? after 1 week, gradually increase your activities and distance walked as you can tolerate ?????? no driving until you are no longer taking pain medications ?????? call and schedule an appointment to be seen in weeks for post procedure check and cta what to report to office: ?????? numbness, coldness or pain in lower extremities ?????? temperature greater than 101.5f for 24 hours ?????? new or increased drainage from incision or white, yellow or green drainage from incisions ?????? bleeding from groin puncture site sudden, severe bleeding or swelling (groin puncture site or incision) ?????? lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. if bleeding stops, call vascular office. if bleeding does not stop, call 911 for transfer to closest emergency room. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: followup instructions: provider: . phone: date/time: 8:00 please call dr. office to arrange an office visit in 2 weeks. you will have a cta prior to your office visit. procedure: other revision of vascular procedure hemodialysis aortography endovascular implantation of graft in thoracic aorta diagnoses: other primary cardiomyopathies anemia in chronic kidney disease end stage renal disease congestive heart failure, unspecified thoracic aneurysm without mention of rupture chronic airway obstruction, not elsewhere classified gout, unspecified peripheral vascular disease, unspecified diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to