Conversion to Open Repair After Endografting for Abdominal Aortic Aneurysm: A Review of Causes, Incidence, Results, and Surgical Techniques of Reconstruction

Abstract

Though the incidence is gradually declining, secondary interventions persist as the Achilles' heel of EVAR. A lifelong follow-up strategy for AAA patients treated with EVAR is essential for early detection and treatment of complications of the procedure. Vascular surgeons should be familiar with the complex open conversion procedures.

Conversion to Open Repair from Emergency EVAR in a Patient with Ruptured AAA: Report of a Case

“…Among 24 patients with available information, the cause of open conversion was: access difficulties in 5, type I endoleak and/ or stent-graft migration in 4, continued blood loss in 4, inadvertent renal artery overstenting in 1, stent-graft thrombosis in 1, inability to catheterize the contralateral limb in 1, unspecified endoleak in 1, technical error in 1, and unknown information in 6. 11) In our case, a Zenith ® endograft containing suprarenal bare metal stent as a fixation system was implanted. Therefore, total removal of endograft necessitates a suprarenal or supraceliac cross-clamp.…”

Long-Term Outcomes of Endovascular Repair versus Open Repair of Abdominal Aortic Aneurysm

“…On the other side, a large aneurysm, co-morbidity or previous abdominal surgery would significantly increase the risks of open repair; this situation warrants the use of EVAR. Furthermore, surgeons' learning curve and advances in device technology are considerations in interpreting these results, [12][13][14] even though we did not compare these factors.…”

Open Reintervention for Aneurysmal Sac Enlargement after EVAR

“…Therefore, direct clamping of these relatively stiff endoprostheses can lead to the risk of insufficient aortic control and damage to the aortic tissues if the supra-renal bare metal stent or fixation barbs tear the aorta. 5) Although "the clamp and pull" complete endograft extraction approach was suggested by several surgeons, 6,7) this is considered to be a very hazardous approach because of the existence of transrenal fixated endografts as the bare metal stent becomes incorporated into the juxtrenal aortic lining with a layer of neointima. 8) Therefore, endograft extraction using infection.…”

“…However, it is important to note that further close and regular surveillance is necessary to establish if the long-term results of this technique are superior to that of other reported surgical options. [5][6][7][8][9][10][11] …”