Outcomes after Partial Endograft Explantation

Steenberge, Sean P.; Lyden, Sean P.; Turney, Eric J.; Kelso, Rebecca; Srivastava, Sunita; Eagleton, Matthew J.; Clair, Daniel G.

doi:10.1016/j.avsg.2015.09.018

Cited by 8 publications

(3 citation statements)

References 16 publications

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“…11 The distal portion of the endoprosthesis was preserved in case of apparent incorporation of the graft into the vessel wall. 12 Exclusion criteria for this technique were the presence of endograft infection and complete aneurysmal degeneration of the proximal neck with consequential transformation in juxtarenal or thoracoabdominal aneurysm.…”

Section: Methodsmentioning

confidence: 99%

Infrarenal endograft clamping in late open conversions after endovascular abdominal aneurysm repair

Perini

Troia

Tecchio

et al. 2017

Journal of Vascular Surgery

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Section: Methodsmentioning

confidence: 99%

Infrarenal endograft clamping in late open conversions after endovascular abdominal aneurysm repair

Perini

Troia

Tecchio

et al. 2017

Journal of Vascular Surgery

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“…Of the two types of open aortic procedures requiring remedial secondary interventions, this type is a bit more frequent and less technically challenging. [3][4][5] Typically, these patients present many years after placement of an endograft and have had frequent and numerous interventions for aneurysm growth directed at occluding either the lumbar arteries or the inferior mesenteric artery. Table 1 describes the types of approaches.…”

Section: Exposure and Salvage Of Endograftmentioning

confidence: 99%

Explant of the Aortic Endograft: Today’s Solutions, Tomorrow’s Problems

Lumsden

2023

Methodist DeBakey Cardiovascular Journal

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Type 2 endoleaks remain the Achilles heel of abdominal aortic endografting. They drive imaging costs and repeat intervention. We believe that after two endovascular interventions, patients should be considered for either graft explantation or graft salvage through an open abdominal exploration. Graft explantation has been associated with increased morbidity and mortality but remains necessary in the face of non-correctible type 1a endoleaks, graft failure, or graft infection. In the majority of cases AAA expansion due to persistent type 2 endoleak is the culprit. In this situation, open repair, with oversewing of the lumbar or inferior mesenteric arteries, can be accomplished providing the seal zones and component overall zones are adequate. This approach does not require aortic clamping. We provide detailed descriptions and videos to facilitate the surgeon in performing these complex procedures.

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“…There is paucity of information in the literature evaluating repair of failed EVARs when multiple approaches are available. [18][19][20][21][22][23] It is not clear whether there is one modality that is superior to another or whether operative approach is based solely on indication for rescue. The objective of this study was to evaluate clinical management and rescue of failed EVARs by either explantation or F/B-EVAR.…”

mentioning

confidence: 99%

Management of failed endovascular aortic aneurysm repair with explantation or fenestrated-branched endovascular aortic aneurysm repair

Dias

Farivar

Steenberge

et al. 2018

Journal of Vascular Surgery

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Objective: The incidence of failed endovascular aneurysm repair (EVAR) is increasing, and understanding the different methods of management and repair is paramount. The objective of this study was to evaluate the clinical management and rescue of failed EVAR by either explantation or fenestrated-branched EVAR (F/B-EVAR).Methods: A retrospective analysis (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) of 247 patients who underwent either explantation (n ¼ 162) or F/B-EVAR (n ¼ 85) for failed EVAR was performed. F/B-EVAR was performed under a physician-sponsored investigational device exemption. Demographics of the patients, clinical presentation and failure etiology, perioperative management, rate of reinterventions, morbidity, and mortality were analyzed. Those undergoing surgical explantation were compared with those undergoing F/B-EVAR conversion. Statistical analysis included multivariable logistic regressions, Fisher exact test, and c 2 test. Results:The majority of patients were male (n ¼ 216 [87%]), with a mean age of 75 years (range, 50-93 years). The mean time from primary EVAR was higher in F/B-EVAR (46 6 7 months vs 69 6 41 months; P < .001). Graft manufacturer did not differ between those requiring explantation and those having endovascular rescue (P ¼ .170). All emergencies (n ¼ 24 [10%]) and infections (n ¼ 28 [11%]) were treated with open conversion. Endoleak was the most common reason for failure in both explantation and F/B-EVAR groups (75% vs 64%, respectively; P ¼ .052). Type I endoleak was the most common endoleak reported in both groups, occurring more frequently in F/B-EVAR (64% vs 40%; P < .001); type II endoleak was more common in those undergoing open repair (28% vs 2%; P < .001). Graft migration (12% vs 26%; P ¼ .005) and neck degeneration/disease progression (14% vs 59%; P < .001) were more prevalent in F/B-EVAR, but aneurysm enlargement was more common in explantation (68% vs 33%; P < .001). Thirty-day reintervention rates did not differ between F/B-EVAR and explantation (odds ratio, 0.6258; 95% confidence interval, 0.2-1.86; P ¼ .4115); however, 30-day mortality was lower in the F/B-EVAR group (5% vs 10%; P ¼ .0192). Similarly, aneurysm-related mortality was also lower in the F/B-EVAR group (hazard ratio, 0.0683; 95% confidence interval, 0.01-0.44; P ¼ .0048). A subset analysis excluding emergencies and infections did not alter the lack of difference in terms of freedom from reinterventions (P ¼ .1175), 30-day mortality (P ¼ .6329), or aneurysm-related mortality (P ¼ .7849).Conclusions: Explantation and F/B-EVAR are necessary options in treating patients with failed EVAR, and both techniques have competitive results. Different modes of failure may point to a preferred method of treatment; consequently, rescue of failed EVAR should be individualized according to each patient's presentation and resources available.

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Outcomes after Partial Endograft Explantation

Cited by 8 publications

References 16 publications

Infrarenal endograft clamping in late open conversions after endovascular abdominal aneurysm repair

Infrarenal endograft clamping in late open conversions after endovascular abdominal aneurysm repair

Explant of the Aortic Endograft: Today’s Solutions, Tomorrow’s Problems

Management of failed endovascular aortic aneurysm repair with explantation or fenestrated-branched endovascular aortic aneurysm repair

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