Related Experiment Video
Updated: Jun 26, 2026
08:51
A New Murine Model of Endovascular Aortic Aneurysm Repair
Published on: July 7, 2013
Increasing Technical Complexity of EVAR Conversion over Time Is Not Associated with Worse Outcomes at a High-Volume
Michael J Fassler1, Salvatore T Scali1, Griffin P Stinson1
1Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville.
Annals of Vascular Surgery
|June 24, 2026
Summary
Open conversion after endovascular aneurysm repair (EVAR-c) is increasingly complex and delayed, indicating later referral for EVAR failure. Despite this, perioperative outcomes remain stable, highlighting the importance of specialized aortic centers.
Area of Science:
- Vascular Surgery
- Endovascular Surgery
- Aortic Aneurysm Repair
Background:
- Open conversion after endovascular aneurysm repair (EVAR-c) is a strategy for EVAR failure.
- The evolution of EVAR-c practice, influenced by surveillance and salvage techniques, is not well understood.
- Increasing complexity and delayed referrals are hypothesized for EVAR-c at aortic centers.
Purpose of the Study:
- To investigate the temporal evolution of EVAR-c practice.
- To analyze changes in operative complexity, referral timing, and failure phenotypes over time.
- To evaluate perioperative outcomes and survival in relation to EVAR-c complexity.
Main Methods:
- A retrospective analysis of 294 EVAR-c procedures stratified into three eras based on volume.
- Primary outcome: temporal changes in operative complexity variables.
- Secondary outcomes: 30-day mortality, time to conversion, failure phenotype, length of stay, and complications.
Main Results:
- Time from EVAR to conversion significantly increased across eras (p<.001).
- Operative complexity increased, with greater use of retroperitoneal exposure (p=.006) and renal/visceral bypass (p<.001).
- Elective 30-day mortality numerically declined, while non-elective mortality remained unchanged; major complications and length of stay were similar.
Conclusions:
- EVAR-c has evolved towards later referral and increased operative complexity, reflecting progressive endograft failure.
- Despite rising complexity, perioperative outcomes for EVAR-c have remained stable.
- Specialized aortic centers play a crucial role in managing complex EVAR-c cases.
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