Open Conversion After Endovascular Aortic Aneurysm Repair: A Single-Center Experience

Ferrero, Emanuele; Ferri, Michelangelo; Viazzo, Andrea; Pecchio, Alberto; Berardi, Giuseppe; Piazza, Salvatore; Ripepi, Matteo; Benintende, Emilio; Nessi, Franco

doi:10.1016/j.avsg.2012.06.031

Cited by 20 publications

(13 citation statements)

References 33 publications

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“…However, most surgeons still perform open AAA repairs when the anatomy does not favor the use of EVAR, and occasionally EVAR may be converted to open repair during or after the repair due to technical failure on deployment, inappropriate stent-graft placement, vessel rupture, or graft thrombosis [ 9 11 12 ]. Overall rates of open conversion of up to 6% have been reported in large EVAR series, and the incidence of early conversion (<30 days after stent-graft implantation) varies from 0.3% to 5.9% in the English-language literature [ 11 12 13 14 15 ]. More recent studies have reported lower rates of early conversion to open surgery, which is probably due to improvements in endograft technology and endovascular technique, better patient selection, and a tendency to treat most complications via the endovascular approach.…”

Section: Discussionmentioning

confidence: 99%

A new risk-scoring model for predicting 30-day mortality after repair of abdominal aortic aneurysms in the era of endovascular procedures

Kim

Han

et al. 2016

Ann Surg Treat Res

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PurposeTo propose a new, multivariable risk-scoring model for predicting 30-day mortality in individuals underwent repair of abdominal aortic aneurysms (AAA).MethodsFour hundred eighty-five consecutive patients who underwent AAA repair from January 2000 to December 2010 were included in the study. Univariate and multivariate analyses were performed to evaluate the risk factors, and a risk-scoring model was developed.ResultsMultivariate analysis identified three independent preoperative risk factors associated with mortality, and a risk-scoring model was created by assigning an equal value to each factor. The independent predictors were location of the AAA, rupture of AAA, and preoperative pulmonary dysfunction. The multivariable regression model demonstrated moderate discrimination (c statistic, 0.811) and calibration (Hosmer-Lemeshow test, P = 0.793). The observed mortality rate did not differ significantly from that predicted by our risk-scoring model.ConclusionOur risk-scoring model has excellent ability to predict 30-day mortality after AAA repair, and awaits validation in further studies.

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Section: Discussionmentioning

confidence: 99%

A new risk-scoring model for predicting 30-day mortality after repair of abdominal aortic aneurysms in the era of endovascular procedures

Kim

Han

et al. 2016

Ann Surg Treat Res

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“…Endoleak was the most common indication for explant. In 2013, Ferrero et al 21 reported on a series of 26 patients with explant performed for 22 endoleaks (13 type I, 5 type II, 2 type III, and 2 type V). In 2014 the Cleveland clinic published a series of 100 explants, in which endoleak accounted for 82% of those explanted (type I, 40%; II, 30%; III, 22%; endotension, 6%; multiple, 16%).…”

Section: Discussionmentioning

confidence: 99%

Explant of aortic stent grafts following endovascular aneurysm repair

et al. 2019

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Background Failure of endovascular aneurysm repair may require explant of the stent graft in a subset of patients. We sought to assess outcomes in a cohort of patients undergoing explant of endovascular aneurysm repair in both emergency and elective settings. Methods Patients undergoing explant of endovascular aneurysm repair were identified from a prospectively maintained database, with additional information obtained through retrospective analysis of medical records. Results Over a 21-year period, 1997–2018 (May), there were 597 endovascular aneurysm repair procedures performed in our institution for abdominal aortic aneurysm. There were 19 endovascular aneurysm repair explants; five of these were referrals from other vascular centres. The median age was 73 years (range 46–81). The median length of time from insertion to explant was 39.2 months (range 0–153). Indications for elective explant were type Ia endoleak (n = 4), type 1b endoleak (n = 1), type II endoleak with increasing sac size (n = 1), type I/III endoleak (n = 1), type IV endoleak (n = 1), and increasing sac size without evident endoleak (type V, n = 2). The remaining nine cases were emergency procedures, with four patients presenting with rupture post endovascular aneurysm repair, four patients presenting with acute stent thrombosis, of which one also had a type 1a endoleak and one aorto-enteric fistula. There were no mortalities in the elective group and three mortalities in the emergency group (0 vs 33.3%, p = 0.087). Overall 30-day mortality was 15.8% Conclusion Explant of aortic stent grafts can be associated with high mortality and morbidity rates, especially in the emergent setting. Patient and device selection and post-operative surveillance remain vitally important to optimise outcomes post endovascular aneurysm repair.

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“…Cardiac complications, hemorrhage, iatrogenic injuries, renal failure, distal embolization, gastrointestinal and respiratory complications. Moreover the incidence of late complications as pseudo aneurysms as well infection of the graft was observed with an incidence of 1.4% [13][14][15][16][17][18].…”

Section: Complicationsmentioning

confidence: 97%

Open Conversion after EVAR: Indications and Technical Details

Siani¹,

Accrocca²,

Castrucci³

et al. 2019

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice

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Endovascular aortic aneurysm repair (EVAR) is widely used for the treatment of abdominal aortic aneurysms. Complications secondary to EVAR are also treated with endovascular techniques. When this is not applicable, open surgical repair is mandatory. Surgical re-intervention following EVAR is considered to be more demanding compared with primary open repair and it is related to the type of endograft implanted (infra renal vs. suprarenal fixation), to the indications for surgical conversion (infection vs. non infection), to the setting of presentation (elective vs. emergency) and type of conversion (total vs. partial). While technically challenging, delayed open conversion of EVAR can be accomplished with low morbidity and mortality in both the elective and emergent settings. These results reinforce the justification for long-term surveillance of endografts following EVAR.

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Open Conversion After Endovascular Aortic Aneurysm Repair: A Single-Center Experience

Cited by 20 publications

References 33 publications

A new risk-scoring model for predicting 30-day mortality after repair of abdominal aortic aneurysms in the era of endovascular procedures

A new risk-scoring model for predicting 30-day mortality after repair of abdominal aortic aneurysms in the era of endovascular procedures

Explant of aortic stent grafts following endovascular aneurysm repair

Open Conversion after EVAR: Indications and Technical Details

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