Open AAA – Juxtarenal

Gabrielle Morris

77 y/o F with 5.5cm juxtarenal AAA- complex EVAR therefore preference for open procedure, and recent increase in size.

Patient’s sister died from AAA rupture leading to significant patient anxiety and exercise avoidance.

Background

  • Dyslipidaemia
  • Current Smoker- 75 year pack history. Reduced – currently 3/day. Normal spiro.
  • CFS: 4

Issues

  • Elevated risk CPET results – low AT (8.9ml/kg/min), acceptable peak VO2 (16.4). 

Discussion

  • Absence of respiratory issues (beyond residual smoking) to deter from open procedure
  • BP remained within target range for known AAA (<180 systolic) during CPET suggesting prehabilitative exercise will be feasible
  • Patient engaged in planning prehabilitation. Previously active so understands the feel/goals of activity. 

Plan

  • Pre-habilitation 4-6 weeks, no need to repeat CPET 

Proceed to open procedure