Late open conversion after thoracic endovascular aortic repair

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Endovascular aortic repair (TEVAR) is increasingly used for aortic aneurysms and dissections.
• Late complications after TEVAR may necessitate conversion to open surgical repair.
• Understanding outcomes of open conversion is crucial for patient management.

Purpose of the Study:

• To review outcomes of late open conversion after TEVAR.
• To identify reasons for conversion and associated complications.
• To evaluate survival rates after open conversion for TEVAR complications.

Main Methods:

• Retrospective review of 538 patients undergoing TEVAR between 1994 and 2017.
• Analysis of 33 patients requiring late open conversion.
• Review of demographics, reasons for conversion, surgical techniques, outcomes, and survival.

Main Results:

• Common indications for conversion included endoleak, new entry tear, and dissection.
• Hospital mortality was 9.1%, primarily in patients with aortic arch involvement.
• 10-year survival was significantly worse for patients with aortic arch involvement (48.1%) compared to those without (86.1%).

Conclusions:

• Open conversion after TEVAR for late complications can be successful.
• Aortic arch involvement is associated with poorer outcomes.
• Lifelong surveillance and timely open conversion are recommended for better results.