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Early elective conversion for failing EVAR.

P S Aho1, W D Roth, P Keto

  • 1Department of Vascular Surgery, Helsinki University Central Hospital, Finland. pekka.aho@hus.fi

Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society
|November 2, 2005
PubMed
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Elective conversion to open surgery after endovascular aneurysm repair (EVAR) is safe and effective. Urgent conversions, however, are associated with higher mortality, suggesting elective conversion may be a better strategy for failing stent-grafts.

Area of Science:

  • Vascular Surgery
  • Endovascular Interventions
  • Aortic Aneurysm Treatment

Background:

  • Endovascular aneurysm repair (EVAR) has become a standard treatment for abdominal aortic aneurysms.
  • Long-term outcomes of EVAR, particularly conversion procedures, require further investigation.
  • Assessing elective conversion outcomes is crucial for refining EVAR management strategies.

Purpose of the Study:

  • To evaluate the long-term results of EVAR for abdominal aortic aneurysms.
  • To specifically analyze the outcomes of elective conversion procedures following EVAR.
  • To compare the safety and efficacy of elective versus urgent conversions.

Main Methods:

  • Prospective data collection of 110 elective EVAR procedures.
  • Evaluation of treatment results and follow-up data.

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  • Analysis of conversion types (elective, secondary, urgent) and their outcomes.

    • Main Results:

    • 21% (23/110) of EVAR patients required conversion to open surgery.
    • 0% 30-day mortality for elective EVAR and elective conversions (n=20).
    • Urgent conversions (3%) had a 9% overall mortality (2/23), with elective conversions showing 0% five-year aneurysm-related mortality.

    Conclusions:

    • Elective conversion is a safe alternative for managing failing first-generation stent-grafts.
    • Urgent conversions are associated with significantly higher mortality risks.
    • Considering elective conversion may reduce mortality compared to urgent interventions or repeated endovascular procedures.