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Late open conversion after TEVAR.

Germano Melissano1, Yamume Tshomba, Daniele Mascia

  • 1Unit of Vascular Surgery, Cardio-Thoracic Department, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy - melissano.germano@hsr.it.

The Journal of Cardiovascular Surgery
|April 23, 2016
PubMed
Summary
This summary is machine-generated.

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Postdissection thoracoabdominal aortic aneurysm presenting with narrow true lumen: Outcomes after fenestrated and branched endovascular repair from the international multicenter NArrow-true-lumen DIssection Registry (NADIR) study group.

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Late open conversion (LOC) after thoracic endovascular aortic repair (TEVAR) is feasible, often involving partial stent-graft removal. Outcomes indicate higher risks for infection, fistula, and dissection complications.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Endovascular Repair

Background:

  • Late open conversion (LOC) after thoracic endovascular aortic repair (TEVAR) presents unique challenges.
  • Characterizing indications, methods, and outcomes is crucial for patient management.

Purpose of the Study:

  • To analyze indications for LOC following TEVAR.
  • To describe surgical repair methods used in LOC procedures.
  • To report patient outcomes after LOC.

Main Methods:

  • Retrospective analysis of 30 patients undergoing LOC after TEVAR (1999-2015).
  • Detailed recording of indications, surgical techniques (e.g., partial stent-graft removal, bypass, CSF drainage), and complications.
  • Follow-up assessment of patient outcomes.

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Main Results:

  • Indications included distal aortic disease progression (30%), stent-graft infection/fistulization (33.3%), retrograde dissection (20%), endoleak (10%), and device issues (6.7%).
  • Perioperative mortality was 16.6%, with higher rates for infection (20%) and dissection (33%).
  • Common complications included respiratory failure (23.3%) and paraplegia (3.3%).

Conclusions:

  • Open conversion after TEVAR is feasible, with the proximal stent-graft often left in place.
  • Infection, fistula, and retrograde dissection significantly increase the risk of death and morbidity.