Conversion from endovascular to open abdominal aortic aneurysm repair

Area of Science:

• Vascular Surgery
• Abdominal Aortic Aneurysm Repair
• Endovascular Aneurysm Repair

Background:

• Conflicting data exists on operative risks of converting to open repair after failed endovascular aneurysm repair (EVAR).
• Understanding these risks is crucial for patient management and treatment planning.
• Previous studies have not consistently identified factors associated with conversion procedures.

Purpose of the Study:

• To assess outcomes of patients undergoing conversion to open repair after EVAR failure.
• To compare outcomes of conversion repair with standard open abdominal aortic aneurysm (AAA) repair and primary EVAR.
• To identify patient and aneurysm characteristics associated with conversion.

Main Methods:

• Utilized data from the National Surgical Quality Improvement Program (2005-2013).
• Included patients undergoing conversion, standard EVAR, and open AAA repair.
• Employed multivariable logistic regression to identify conversion factors and assess perioperative risks.

Main Results:

• Conversion was associated with significantly higher 30-day mortality versus standard open repair (10.0% vs 4.2%) and EVAR (10.0% vs 1.7%).
• Conversion surgery increased the occurrence of any complication compared to open repair (OR, 1.5) and EVAR (OR, 7.8).
• Factors associated with conversion included young age, female gender, nonwhite race, and larger aneurysm diameter; obesity was inversely associated.

Conclusions:

• Conversion to open repair following EVAR failure significantly increases perioperative morbidity and mortality.
• Key factors predicting conversion include large aneurysm diameter, young age, female sex, and nonwhite race.
• Obesity appears to be a protective factor against conversion to open AAA repair.