Single-Center Experience with Open Explantation After Failed Endovascular Abdominal Aortic Aneurysm Repair

Open explantation after endovascular aneurysm repair (EVAR) is technically demanding and associated with significant morbidity and mortality, yet single-center data are limited. This study aimed to evaluate perioperative outcomes and long-term survival following EVAR explantation at a high-volume vascular center.

A retrospective review was conducted of all consecutive patients who underwent EVAR explantation between 2010 and 2024. Demographics, comorbidities, imaging findings, operative details, postoperative complications, and survival were collected. The primary outcome was 30-day mortality. Secondary outcomes included overall survival, major complications, and cause-specific late mortality.

Twenty-six patients underwent open EVAR explantation (mean age 75.7 ± 7.7 years, 92% male), with a median interval of 4.9 (interquartile [IQR] 1.8-8.5) years between index EVAR and conversion. Indications included type II endoleak (31%), type I endoleak (35%), and graft infection or thrombosis (24%). Pulmonary complications occurred in 12% and gastrointestinal complications in 8%. Thirty-day mortality was 3.8%. Mean intensive care unit (ICU) and total hospital stay was 10.0 ± 16.4 days and 17.3 ± 16.0 days, respectively. Kaplan-Meier survival analysis demonstrated estimated survival rates of 78.6% at 1 year, 73.0% at 3 years, and 64.9% at 5 years.

Open surgical conversion after EVAR carries substantial morbidity but, when performed electively in specialized centers, may be associated with acceptable perioperative mortality and durable long-term survival in selected patients. These findings highlight the importance of lifelong surveillance following EVAR, strict adherence to device instructions for use (IFU), and meticulous perioperative planning to optimize outcomes in this high-risk population.