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Conversión Quirúrgica Abierta tras Reparación Endovascular de Aneurisma en Japón: Indicaciones y Resultados de un

Koichi Morisaki¹, Masaki Sano², Keisuke Miyake³

¹Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Journal of vascular surgery

|January 16, 2026

Abstracto

Objective:

This study aimed to evaluate indications and outcomes of open surgical conversion (OSC) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) using a multicenter registry in Japan.

Methods:

Thirteen vascular centers retrospectively reviewed patients who underwent OSC after prior EVAR between 2006 and 2024. Baseline characteristics, indications, procedural details, and outcomes were analyzed. Primary endpoint was 30-day mortality. Secondary endpoints were overall survival (OS), aneurysm-related survival, and freedom from retreatment.

Results:

A total of 208 patients (85.6% males, median age 78 years) were included. Median age was 78 years, 85.6% were male, and median AAA diameter was 62mm. Median interval from initial EVAR to OSC was 5.2 years. Indications for OSC were type 2 endoleak with sac enlargement (47.1%), type 1 endoleak (23.1%), type 5 endoleak with sac enlargement (13.0%), infection (10.1%), and type 3 endoleak (9.6%). The most frequently used stent graft was Excluder, followed by Endurant and Zenith. Complete stent graft removal was performed in 41 patients, partial removal in 51, and 116 underwent OSC with stent graft preservations. Thirty-eight patients (18.3%) presented with rupture, and 48 (23.1%) underwent urgent OSC. Thirty-day mortality was 4.3% in overall cohort, 2.4% in non-ruptured cases, and 13.2% in ruptured cases. Rupture was a risk factor for the 30-day mortality (hazard ratio, 5.93; 95% confidence interval, 1.59-22.1; P = .008). At 10 years, OS and aneurysm-related mortality were 58.4% and 14.8%, respectively, while freedom from retreatment rate was 87.5% at 10 years.

Conclusion:

Type 2 endoleak was the leading common indication for OSC after EVAR in this multicenter retrospective study in Japan. Rupture at OSC markedly increased 30-day mortality, even in patients with type 2 endoleak. Further studies are needed to refine elective indications for OSC to prevent aneurysmal rupture and avoid treatment delay.

Palabras clave:

aneurisma de aorta abdominal fuga (EL)reparación endovascular de aneurisma (EVAR)infección conversión quirúrgica abierta (OSC)

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