Surgical conversion after endovascular grafting for abdominal aortic aneurysms

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Repair

Background:

• Endovascular grafting has become a primary treatment for abdominal aortic aneurysms (AAA).
• Conversion to open repair may be necessary due to technical challenges or complications.
• Understanding conversion rates and indications is crucial for optimizing endovascular AAA repair outcomes.

Purpose of the Study:

• To analyze the indications, outcomes, and technical issues related to conversion after endovascular AAA repair.
• To evaluate a 6-year experience with endovascular grafting for AAA.

Main Methods:

• A cohort of 520 patients with AAA undergoing endovascular therapy between August 1994 and May 2000 was analyzed.
• Conversions to open repair were performed based on specific indications, timing, and endograft type.
• Data from computed tomography and aortography informed patient selection.

Main Results:

• Conversion to open repair was required in 7.1% of cases (37 patients).
• Primary conversions were mainly due to device defects or access issues, while secondary conversions were often caused by type I endoleak.
• Conversion rates were higher for modular (5.9%) versus unibody (1.4%) devices, and decreased over time. Emergency conversions had a 40% mortality rate.

Conclusions:

• Bifurcated devices are often necessary for complete AAA exclusion.
• Experience with endovascular grafting reduces primary conversion rates.
• Emergency open repair following endovascular treatment of AAA is associated with high mortality.