Outcomes of Partial Endograft Explantation for Noninfectious Failures After Endovascular Aneurysm Repair: A...

Late open conversion (LOC) after endovascular aneurysm repair (EVAR) remains challenging, and an optimal surgical strategy has not yet been established. We evaluated the clinical outcomes and mid- to long-term durability of surgical reconstruction using a standardized strategy for partial explantation in a regional, real-world setting.

We retrospectively reviewed data from 29 consecutive patients who underwent LOC for noninfectious EVAR failure between July 2013 and December 2025. Clinical outcomes were evaluated using follow-up data available through April 2026. The primary surgical strategy consisted of elective conversion, infrarenal clamping, and partial endograft explantation with "neo-neck" creation whenever feasible.

Elective LOC was performed for progressive aneurysm sac enlargement in 27 patients (93.1%); type II endoleak was the predominant preoperative finding (n = 16; 55.2%). The remaining two patients underwent urgent LOC for bilateral endograft limb thrombosis with lower-extremity ischemia (n = 1) or symptomatic sac enlargement with suspected impending rupture (n = 1). Partial explantation was performed in 28 patients (96.6%). The 30-day mortality rate was 6.9% (n = 2). During the median follow-up period of 44 (range, 0-152) months, no late aortic-related events attributable to the retained endograft components were observed. The estimated 5-year overall survival and freedom from aortic-related events were 88.9% and 93.1%, respectively.

The standardized partial explantation strategy was feasible in selected patients undergoing LOC for noninfectious EVAR failure and was associated with acceptable perioperative outcomes and mid- to long-term reconstructive durability even in a low-volume, real-world setting.