Late open conversion after failed endovascular aortic aneurysm repair.

Area of Science:

• Vascular Surgery
• Endovascular Interventions

Background:

• Endovascular aortic aneurysm repair (EVAR) is a common treatment for abdominal aortic aneurysms.
• Complications from EVAR often require further endovascular treatment, but open surgical repair is necessary when endovascular options fail.

Purpose of the Study:

• To present the authors' experience with open surgical repair following failed EVAR.
• To analyze the outcomes and challenges associated with late open conversions after EVAR.

Main Methods:

• A retrospective review of 18 patients who underwent open surgical repair after EVAR failure between 2004 and 2013.
• Analysis of reasons for EVAR failure, including endoleaks, stent graft thrombosis, and aortoenteric fistulae.
• Detailed description of surgical techniques, including stent graft management (ligation, partial/complete removal) and aortic clamping necessity.

Main Results:

• The mean interval between EVAR and open conversion was 36 months.
• Most operations (83.3%) were elective, while 16.7% were urgent due to rupture or fistula.
• Overall operative mortality was 5.6%, with complications including abdominal wall defects and pulmonary infections.

Conclusions:

• Late open conversion after EVAR is a complex procedure.
• Avoiding aortic cross-clamping and preserving the stent graft, if possible, may reduce operative mortality and morbidity.
• Elective conversions are associated with better outcomes, emphasizing the importance of close EVAR patient surveillance and timely intervention.