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Lessons Learned from Open Surgical Conversion after Failed Previous EVAR.

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Open conversion (OpC) after endovascular aortic aneurysm repair (EVAR) is increasingly common. While technically successful, OpC carries significant mortality, especially in patients with hemorrhagic shock or active fixation endografts.

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Area of Science:

  • Vascular Surgery
  • Endovascular Repair
  • Aortic Aneurysm Management

Background:

  • Delayed open conversion (OpC) following endovascular aortic aneurysm repair (EVAR) is a growing clinical concern.
  • Understanding the perioperative characteristics of these complex cases is crucial for improving patient outcomes.

Purpose of the Study:

  • To characterize the perioperative spectrum of open conversion repairs after failed EVAR.
  • To identify factors influencing outcomes in patients undergoing late OpC.

Main Methods:

  • Retrospective analysis of a prospectively maintained institutional database.
  • Inclusion of patients who underwent late OpC after EVAR failure.
  • Examination of baseline characteristics, failure mechanisms, perioperative details, and late outcomes.

Main Results:

  • 38 male patients underwent late OpC, with a mean interval of 63.6 months post-EVAR.
  • Common failure mechanisms included endoleaks (types Ia, Ib, II, III), infection, and leg ischemia.
  • 30-day mortality was 21.1%, significantly higher in patients with hemorrhagic shock, hemodynamic instability, or endografts with hooks/barbs.

Conclusions:

  • Open conversion after EVAR has a high technical success rate but significant associated mortality.
  • Hemorrhagic shock, active fixation endografts, and high complication rates are associated with increased mortality.
  • Further research is needed to explore other confounding factors impacting OpC outcomes.