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Updated: May 14, 2026
04:56
Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
Delayed open conversion after endovascular abdominal aortic aneurysm: device-specific surgical approach
E M Marone1, D Mascia, G Coppi
1Vascular Surgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
Summary
Delayed open conversion (dOC) after endovascular abdominal aortic repair (EVAR) is a life-saving procedure for failed EVAR, offering good outcomes. This study details dOC in 54 patients, noting a 1.9% mortality and 78% survival at 19 months.
Area of Science:
- Vascular Surgery
- Endovascular Repair
- Abdominal Aortic Aneurysm
Background:
- Endovascular Abdominal Aortic Aneurysm Repair (EVAR) has advanced, yet delayed open conversion (dOC) is increasingly necessary for EVAR failures.
- EVAR is now used in younger patients, irrespective of their suitability for open repair, potentially increasing future dOC rates.
Purpose of the Study:
- To evaluate the outcomes of delayed open conversion (dOC) in patients with failed endovascular abdominal aortic repair (EVAR).
- To analyze the indications, procedural details, complications, and survival rates associated with dOC.
Main Methods:
- A prospective database collected data on 54 EVAR patients requiring dOC (>30 days post-EVAR) between 2005 and 2011.
- Data included demographics, aortoiliac anatomy, success rates, complications, and follow-up.
- Surgical approaches varied based on stent-graft type; patients with type I/III endoleaks underwent immediate dOC if fit for surgery.
Main Results:
- Common indications for dOC were type I/III endoleaks (34 patients), type II endoleaks with aneurysm growth (13), material failure (4), and infection (3).
- Thirty-day mortality was 1.9%, and overall morbidity was 31%, primarily due to acute renal failure (13 cases).
- Mean hospitalization was 6 days, with overall survival at 19 months follow-up at 78%.
Conclusions:
- Delayed open conversion is a life-saving intervention for EVAR failure, demonstrating satisfactory initial and mid-term results.
- The increasing use of EVAR, including in less ideal candidates, suggests dOC will remain an important salvage procedure.
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