Delayed open conversions after endovascular abdominal aortic aneurysm repair

Abstract

Most OCs after EVAR are associated with significant morbidity and mortality, except when electively treating an isolated type II endoleak with ligation of branches and preservation of the endograft.

Surgical conversion with graft salvage as a definitive treatment for persistent type II endoleak causing sac enlargement

“…This has been shown by some studies that have compared small subgroups of open conversion with and without graft salvage. 20 Several authors 16 have shown that graft salvage seems to be a valid option compared with graft removal, because in some comparative series, the mortality ranges from 1% to 4% when removing the graft and is 0 % when performing sacotomy with graft salvage. 20 This is, as far as we know, the largest case series of semiconversions in the literature.…”

“…20 Several authors 16 have shown that graft salvage seems to be a valid option compared with graft removal, because in some comparative series, the mortality ranges from 1% to 4% when removing the graft and is 0 % when performing sacotomy with graft salvage. 20 This is, as far as we know, the largest case series of semiconversions in the literature. This technique, which was described first by Hinchliffe et al 14 in 2002, permits resolution of the endoleak in most cases by suturing the feeding vessel, and clamping of the aorta is not necessary.…”

Late graft explants in endovascular aneurysm repair

“…Other authors have documented the frequency of endovascular option use before open conversion. 6,7 We reviewed our institution's growing experience for late conversion of failed EVAR to better understand current results, predictors of outcome, and reasons for failure.…”

Open Surgery for Abdominal Aortic Aneurysm in the Era of Endovascular Repair: Comparison with Long Term Results of Endovascular Repair Using Zenith Stentgraft

“…It seems that the initial benefit of EVAR disappears in the intermediate and long term because of the need for frequent, meticulous, and costly follow-up and the potential need for reinterventions. Moreover, late open conversion after EVAR is reported to be associated with significant morbidity and mortality if explant of the stentgraft is inevitable, 12) and under this circumstance, suprarenal, and even supraceliac aortic clamping is often required. 13) Gupta and colleagues reported similar perioperative mortality after open surgery and EVAR in patients which made the aortic bifurcation 58 mm wide.…”