Late conversion of aortic stent grafts

Area of Science:

• Vascular Surgery
• Endovascular Procedures
• Aortic Aneurysm Repair

Background:

• Late removal of endovascular abdominal aortic repair (EVAR) grafts is a growing concern.
• Understanding outcomes of EVAR explants is crucial for refining clinical management and identifying risks.

Purpose of the Study:

• To evaluate the outcomes of patients requiring late explantation of endovascular abdominal aortic repair (EVAR) grafts.
• To identify risk factors for complications and mortality associated with EVAR explants.

Main Methods:

• Retrospective analysis of a patient database for EVAR explants performed more than one month after initial implantation.
• Data collected included graft type, duration of implant, reason for removal, operative technique, mortality, and length of stay.

Main Results:

• Forty-one patients underwent EVAR explantation (median 33.3 months post-implant). Overall hospital mortality was 19%, significantly higher for rupture conversions (P
• Common reasons for explantation included endoleaks (73%), migration, rupture, and aortoenteric fistula. Complete graft removal was achieved in 85% of cases.

Conclusions:

• Elective EVAR conversion can be performed with mortality comparable to primary open repair.
• High mortality persists for conversions due to infected grafts and ruptured aneurysms.
• Lifelong surveillance is recommended for EVAR patients to detect and manage late complications, potentially minimizing associated mortality.