Open Conversion After Endovascular Abdominal Aneurysm Repair: An 8 year Single Centre Experience

To report experience with open conversion (OC) after previous failed EVAR and to compare outcomes of patients undergoing elective OC with those operated on in an urgent setting.

Patients undergoing OC after EVAR between August 2008 and September 2016 were included in this retrospective and observational single institution study. Indications, demographic, anatomical, intra-operative and post-operative data were collected prospectively. Primary endpoints were 30 day and in hospital mortality. Secondary endpoints included moderate to severe complications, secondary interventions, length of intensive care unit, and hospital stay.

OC was performed in 31 patients over the study period: 19 elective and 12 emergency OC, including six ruptures. Median time from index EVAR to delayed OC was 35 months (0-228 months). The most common indications for OC were endoleaks (n = 24, 77%), followed by stent graft infection (n = 3, 10%), thrombosis (n = 3, 10%) and kinking (n = 1, 3%). Eight of the removed stent grafts were Endurant, two were Talent, five Excluder, six Nellix, two AFX, five Zenith, one Vanguard, one Anaconda, and one Seta. Overall in hospital mortality was 10%, with significantly increased in hospital mortality in the emergency group compared with the elective group (25% vs. 0%, p = .049). Renal and pulmonary complications were significantly higher in the emergency group (42% vs. 5%, p = .02 and 42% vs. 0%, p = .005, respectively). No late complication or death was recorded after a mean follow-up of 18 ± 13 months.

Emergency OC is associated with significantly increased in hospital mortality and morbidity compared with elective OC. Elective OC appears to be safer and effective, and should be considered as the best option in cases of EVAR failure to avoid further emergency OC procedures.