Retrospective Cohort Study on EVAR Open Surgical Conversion: Focus on Endoleaks With Wrong Preoperative...

Area of Science:

• Vascular Surgery
• Medical Imaging
• Endovascular Interventions

Background:

• Late open conversion (LOC) after endovascular aneurysm repair (EVAR) is a rare but serious complication.
• It is often a last resort after failed endovascular reinterventions.
• This study investigates imaging limitations contributing to EVAR failures and subsequent LOC.

Purpose of the Study:

• To highlight the limitations of standard EVAR follow-up imaging in accurately characterizing endoleaks.
• To determine the impact of imaging mischaracterization on endovascular reintervention success.
• To identify factors contributing to the need for late open conversion.

Main Methods:

• Retrospective cohort study of 708 EVAR procedures performed between 2008 and 2022.
• Defined elective LOC as surgical conversion >1 month post-EVAR.
• Primary endpoint: rate of incorrect endoleak categorization by follow-up imaging prior to LOC.

Main Results:

• 30 patients (4.2%) required elective LOC, 25 for sac enlargement due to endoleaks.
• Incorrect endoleak categorization occurred in 13 patients (52.2%).
• Most miscategorizations involved Type II endoleaks, often reclassified as Type I, III, or IV, with significant morbidity (28%) and one 30-day mortality.

Conclusions:

• Current follow-up imaging (angioscanner, Doppler ultrasound) has limitations in precise endoleak categorization.
• These limitations may increase the rate of patients requiring late open conversion (LOC).
• Development of advanced, dynamic imaging techniques is needed to improve endoleak characterization and reduce LOC necessity.