Long-Term Outcomes of Open Aneurysmorrhaphy for Sac Expansion After Endovascular Abdominal Aortic Aneurysm Repair

To evaluate the long-term outcomes of open aneurysmorrhaphy (OA) for the treatment of sac enlargement following endovascular abdominal aortic aneurysm repair (EVAR).

This single-center, retrospective cohort study included patients who underwent OA with stent graft preservation for post-EVAR sac enlargement between January 2016 and June 2021. The primary end point was aneurysm-related death. The secondary end points were sac reexpansion and freedom from complex reinterventions, defined as fenestrated EVAR and redo open repair.

A total of 28 patients underwent OA. The mean age at OA was 76.9 years, the median sac diameter at OA was 79 mm, and the median interval from the index EVAR to OA was 82 months. Since 2017, a technical modification to achieve tighter plication has been implemented, and patients were divided into an early group (n = 8) and a late group (n = 20). The 30-day morality was 0%. During a mean follow-up period of 63.0 months, 13 deaths were observed; none were aneurysm-related. At 5 years after OA, overall survival was 63.4%. Freedom from sac reexpansion was 56.1% (early 14.3% vs. late 75.3%), and freedom from complex reintervention was 87.5% (early 58.3% vs. late 100.0%); both rates were significantly higher in the late group (P = 0.002 and P = 0.016, respectively).

This study suggests that OA provides acceptable long-term durability when performed with technical modification. OA appears to be a reasonable option for patients with post-EVAR sac enlargement who are at high risk for stent graft explantation.