Myths and methodologies: Cardiopulmonary exercise testing for surgical risk stratification in patients with an abdominal aortic aneurysm; balancing risk over benefit

Damian M. Bailey*, Richard G. Davies, George A. Rose, Michael H. Lewis, Ahmed Abd Aldayem, Chistopher P. Twine, Wael Awad, Matti Jubouri, Idhrees Mohammed, Carlos A. Mestres, Edward P. Chen, Joseph S. Coselli, Ian M. Williams, Mohamad Bashir, The International Academic Surgical Consortium (THALAMUS)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

The extent to which patients with an abdominal aortic aneurysm (AAA) should exercise remains unclear, given theoretical concerns over the perceived risk of blood pressure‐induced rupture, which is often catastrophic. This is especially pertinent during cardiopulmonary exercise testing, when patients are required to perform incremental exercise to symptom‐limited exhaustion for the determination of cardiorespiratory fitness. This multimodal metric is being used increasingly as a complementary diagnostic tool to inform risk stratification and subsequent management of patients undergoing AAA surgery. In this review, we bring together a multidisciplinary group of physiologists, exercise scientists, anaesthetists, radiologists and surgeons to challenge the enduring ‘myth’ that AAA patients should be fearful of and avoid rigorous exercise. On the contrary, by appraising fundamental vascular mechanobiological forces associated with exercise, in conjunction with ‘methodological’ recommendations for risk mitigation specific to this patient population, we highlight that the benefits conferred by cardiopulmonary exercise testing and exercise training across the continuum of intensity far outweigh the short‐term risks posed by potential AAA rupture.
Original languageEnglish
Article numberEP090816
Pages (from-to)1118-1131
Number of pages14
JournalExperimental Physiology
Volume108
Issue number9
Early online date26 May 2023
DOIs
Publication statusPublished - 14 Jun 2023

Keywords

  • surgical risk stratification
  • perioperative outcome
  • abdominal aortic aneurysm
  • rupture
  • cardiopulmonary exercise testing

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