Elderly male, consultation for consideration of EVAR

PIG Meeting: 24th June 2021

83yo male with a 6.7cm aortic aneurysm. 


  • CAD
  • CABG + MVR 2009 – on warfarin
  • CCF EF 19%
  • COPD on home O2, ex-smoker
  • Severe Pulmonary HTN
  • Last TTE May 2021 – mildly dilated LV with severe global systolic dysfunction, severely dilated LA (volume 53mls/m2), well-seated mechanical mitral valve, severe pulmonary HTN (PASP 68), moderate TR, mild AR, EF 19%


  • Current inpatient with CCF exacerbation
  • Recent reduction in exercise tolerance
  • Referred to ED from perioperative clinic with SpO2 80% after 20m walk. NYHA class 4 dyspnoea.


  • Should surgery proceed?
    • Life expectancy? Is he likely to die from his aneurysm or his cardiorespiratory comorbidities first (rupture rate for 6.7cm AAA is ~ 20% per year)
    • EVAR is a low physiologic stress procedure. 
    • Need clear documentation of ceilings of care (i.e., not for open procedure in emergency or if complications from EVAR)
  • Anaesthetic technique
    • GA may facilitate faster procedure and less IV contrast use (protecting from renal injury) due to improved immobility.
    • Can be done under LA/sedation if patient can lie flat/still and cooperate with breath holds


  • Await outcome of current admission and liaise with surgical team (who are aware of admission)