Late open conversion after endovascular abdominal aortic aneurysm repair

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Abdominal Aortic Aneurysm Treatment

Background:

• Endovascular Aneurysm Repair (EVAR) is a common treatment for abdominal aortic aneurysms.
• Failed EVAR necessitates late open conversion, posing significant clinical challenges.
• Understanding the outcomes of these conversions is crucial for patient management.

Purpose of the Study:

• To determine the incidence, surgical details, and outcomes of late open conversion after failed EVAR.
• To identify the primary indications for late open conversion following EVAR.
• To assess the mortality rates associated with elective versus nonelective open conversions.

Main Methods:

• A comprehensive literature review of studies published between 1991 and 2014 was performed.
• PubMed and EMBASE databases were searched for articles on late conversion after EVAR for abdominal aortic aneurysms.
• Data from 26 articles involving 641 patients were analyzed.

Main Results:

• The cumulative single-center open conversion rate was 3.7%.
• Endoleak was the most frequent indication for conversion (62.4%), followed by infection (9.5%).
• Thirty-day mortality was 9.1%, significantly lower in elective (3.2%) versus nonelective (29.2%) cases.

Conclusions:

• Endoleak remains a critical weakness of EVAR, driving the need for late open conversions.
• Elective open conversions, though technically demanding, are associated with relatively low mortality.
• Open repair remains a valuable option for patients with failed EVAR, especially when endovascular salvage is not feasible.