75-year-old man for assessment of open AAA Repair vs EVAR


  • 5.5cm AAA, asymptomatic
  • COPD – mild, no admissions. 38 pack year smoking history.
  • Lumbar spine fusion
  • Graves’ Disease


  • IHD – angiogram 03/21 shows moderate non-obstructive CAD and normal LV systolic function. Medical therapy only
  • Bilateral foot trauma – work injury many years ago. Multiple surgeries
  • DASI 5.3 MET’s
  • Walks slowly with 4WW due to foot injuries but keeps active, plays lawn bowls.


  • Normal spirometry, TLCO 78%
  • Near-maximal test: RER 1.05 and HRmax 122bpm (82% predicted)
  • Test ceased due to knee pain and anxiety
  • Peak VO2 = 14.6ml/kg/min (61% pred), AT 10.3ml/kg/min
  • Nadir VE/VCO2 elevated at 41.1
  • HRR 6bpm


Open vs Endovascular

  • Consensus that an endovascular approach is preferred in this case
  • Age is a significant limiting factor to open AAA surgery in this patient
  • Discussed with the surgeon and they are keen to proceed with EVAR 
  • Ultimately it is a surgical decision, however they value our collaboration in these complex patients
  • CPET can help guide this decision-making 


  • Performed well on the bicycle
  • Limited by anxiety – elevated nadir VE/VCO2 and low CO2 are indicative of hyperventilation
  • Useful test in this case as patient unable to walk any distance, easy to underestimate functional capacity

Rehabilitation post-procedure

  • Unlikely to be required for EVAR
  • Bicycle-based rehabilitation available at JHH and would be beneficial to this patient


  • Prehabilitation with cycle-based approach
  • Proceed to EVAR