Conversion from endoluminal to open repair of abdominal aortic aneurysms: A hazardous procedure

Abstract

Converting an endoluminal to an open AAA repair may require modifications to the standard open technique and result in a much higher than generally accepted morbidity and mortality rate. Patients rejected for open repair because of co-morbidities ran the same chance of requiring conversion as those without co-morbidities (15-17%). If conversion was required, however, they stood a 3 in 7 or 43% chance of dying.

Late conversion of aortic stent grafts

“…An overall hospital mortality of 19% is consistent with currently published data, but is an improvement over early series that noted mortality as high as 43%. 1,21 The risk of death is largely affected by the emergency and urgent cases for rupture and infection. Our mortality rate for elective conversion for AAA-related issues was 3.3% and compares favorably with the 5% to 8% mortality in observational and randomized controlled studies evaluating open repair.…”

A comparative analysis of the outcomes of aortic cuffs and converters for endovascular graft migration

“…Open repair in these patients can lead to high rates of acute morbidity and mortality. 17 Failing to treat an enlarging aneurysm will eventually result in rupture, necessitating treatment despite a high probability of death. Thus, a secondary endovascular intervention may be the best option for many of these patients.…”

Impact of the Introduction of Endovascular Aneurysm Repair in High-Risk Patients on Our Practice of Elective Treatment of Infrarenal Abdominal Aortic Aneurysms

“…A tricky AAA anatomy does increase the risk of preoperative technical difficulties and therefore of SOT conversion, 19 which is extremely dangerous in these high-risk patients. 20 Even if the mortality rate is comparable to the European literature results, as far as patients with high risk for open surgery [16][17][18] are concerned, it is obvious that comparing a before 2004 historical series with two contemporary series brings forth a bias. This bias is all the more important as the contemporary IIb series includes the very first patients to be operated on according to the endovascular technique, with an inevitable learning-curve period.…”