Long-Term Outcomes of Surgical Explantation for Failed Noninfected Aortic Endografts

Open surgical explantation after failed endovascular aortic repair (EVAR) may be required in selected cases, particularly in patients with type 1a endoleak when endovascular salvage is unfeasible. However, literature on long-term outcomes remains limited. Our study aims to investigate the short- and long-term outcomes of patients who underwent surgical explantation of failed noninfected aortic endograft.

In this retrospective study, patients who underwent open explantation of a failed, noninfected infrarenal EVAR between January 2016 and December 2024 at a tertiary referral center were included. Data on baseline characteristics, initial EVAR, explantation, and outcomes were analyzed. Our primary endpoint was long-term mortality and our secondary endpoints included 30-day adverse events. Kaplan-Meier survival curves were used to visualize the long-term outcomes.

Fifty-two patients were included (41 elective and 11 acute explantation). The primary indication for explantation was type 1a endoleak (88.5%). The 30-day mortality was 2.4% in the elective group and 18.2% in the acute group. Median follow-up was 42.5 months. Estimated 5-year survival was 95% in the elective group and 58% in the acute group. Freedom from reintervention at 5 years was 90% (elective) and 85% (acute). The Nellix endograft was most frequently explanted.

Open explantation of failed, noninfected EVAR is a viable option with favorable outcomes in selected patients. Elective cases show excellent survival and low complication rates, underscoring the importance of timely identification of failure and patient optimization. These findings support explantation as a durable treatment option in selected patients when endovascular alternatives are unsuitable (i.e. anatomic difficulties or access problems).