Open Conversion after EVAR: Indications and Technical Details

Abstract

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.

Laparoscopy versus endovascular aneurysm repair for abdominal aortic aneurysm: A systematic review

“…30,32,33 Furthermore, data regarding the quality of proximal and distal necks used (e.g., length, the presence of calcification and thrombi, angulation, and distal extent) and iliac involvement were unavailable from most of the studies included. This is a significant weakness since large aneurysm size and calcifications are directly related to poorer prognosis and clinical outcome [34][35][36] and could have potentially been a confounding variable.…”