Early and late conversion from endoluminal to open repair

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Abdominal Aortic Aneurysm Treatment

Background:

• Endovascular aneurysm repair (EVAR) is a common treatment for abdominal aortic aneurysms (AAA).
• Complications can necessitate conversion to open surgical repair.
• Understanding indications and techniques for conversion is vital for patient outcomes.

Purpose of the Study:

• To outline the indications for primary and secondary conversion from endovascular to open AAA repair.
• To describe the varied techniques employed in conversion procedures.
• To emphasize the importance of preventative measures to avoid conversion.

Main Methods:

• Review of indications for primary conversion (e.g., rupture, endograft migration).
• Analysis of indications for secondary conversion (e.g., endoleak, infection, continued expansion).
• Description of surgical techniques, including standard, modified standard, and supraceliac control.

Main Results:

• Primary conversion indications include acute events like rupture or graft migration.
• Secondary conversion is indicated for persistent issues such as endoleak, infection, or aneurysm expansion post-EVAR.
• Conversion techniques are tailored to the specific cause of EVAR failure.

Conclusions:

• Conversion to open repair for AAA is a complex procedure with increased risks.
• Careful patient selection, accurate endograft sizing, and meticulous procedural technique are paramount to prevent the need for conversion.
• Avoiding conversion through optimal primary EVAR is the preferred strategy.