title: A systematic review of the role of cardiopulmonary exercise testing in vascular surgery.
abstract: OBJECTIVE
  To perform a systematic review of cardiopulmonary exercise testing (CPET) in the pre-operative evaluation of patients with abdominal aortic aneurysm or peripheral vascular disease requiring surgery.
  
  
  METHODS
  Review methods and reporting were according to the PRISMA guidelines. Studies were eligible if they reported CPET-derived physiological parameters in patients undergoing abdominal aortic aneurysm repair or lower extremity arterial bypass. Data were extracted regarding patient populations and correlation between CPET and surgical outcomes including mortality, morbidity, critical care bed usage and length of hospital stay.
  
  
  RESULTS
  The searches identified 1301 articles. Although 53 abstracts referred to the index vascular procedures, only seven articles met inclusion criteria. There were no data from randomised controlled trials. Data from prospective studies did not comprehensively correlate CPET and surgical outcomes in patients with abdominal aortic aneurysms. There were no studies reporting CPET in patients undergoing lower extremity arterial bypass. Major limitations included small sample sizes, lack of blinding, and an absence of reporting standards.
  
  
  CONCLUSIONS
  The paucity of robust data precludes routine adoption of CPET in risk stratifying patients undergoing major vascular surgery. The use of CPET should be restricted to clinical trials and experimental registries, reporting to consensus-defined standards.
authors.affiliation: Department of Anaesthetics, Royal Surrey County Hospital, Guildford, UK.
authors.forename: E L
authors.initials: EL
authors.lastname: Young
authors.forename: A
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: S
authors.initials: S
authors.lastname: Huddart
authors.forename: R M
authors.initials: RM
authors.lastname: Pearse
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: I M
authors.initials: IM
authors.lastname: Loftus
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.forename: P J E
authors.initials: PJ
authors.lastname: Holt
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D005080:Exercise Test / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D006801:Humans; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D014656:Vascular Surgical Procedures