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[Late surgical conversions after endoprosthetic repair of abdominal aortic aneurysms]
A A Abrosimov1, V V Yamenskov1, A V Obraztsov1
1National Medical Research Center of High Medical Technologies - Central Military Clinical Hospital named after A.A. Vishnevsky' of the Ministry of Defence of the Russian Federation, 143420, Krasnogorsk, Russian Federation.
Background:
Unsatisfactory results of open operations after endoprosthetic repair of abdominal aortic aneurysms are mainly due to technical difficulties of the intervention and associated with a longer time of aortic cross-clamping and a higher frequency of visceral complications.
Objective:
The purpose of this study was to investigate the causes of performing late open operations and their results after endoprosthetic repair of abdominal aortic aneurysms.
Patients And Methods:
We retrospectively analyzed remote outcomes in a total of 82 patients after endoprosthetic repair of abdominal aortic aneurysms, carried out from 2012 to 2022 at the National Medical Research Center of High Medical Technologies - Central Military Clinical Hospital named after A.A. Vishnevsky. Long-term complications developed in 33 (40.2%) patients. Endoleaks turned out to be the most frequent complications encountered in 26 (31.7%) cases. Sixteen (19.5%) patients required repeat surgical interventions. Open surgical conversion was carried out in five (6.1%) patients.
Results:
During late conversions performed emergently for a ruptured aneurysm, two patients died. There were no lethal outcomes in elective interventions. The indications for late conversion in all cases were endoleaks with an increased size or rupture of the aneurysm. Described in the article is a clinical case report regarding successful treatment of a patient with type II endoleak combined with endoprosthesis branch thrombosis and clinical manifestations of critical ischemia of the left lower limb. During open surgery, instead of an aortic cross-clamp we used an occluding aortic balloon placed above the proximal edge of the stent graft.
Conclusion:
An indication for open surgery in the remote period after EVAR is most often an endoleak associated with an increased-size aneurysm and impossibility to perform endovascular correction.
