EVAR後のエンドリークに対する開腹手術修復の成績：中期追跡調査を伴う後向きコホート研究

To assess perioperative safety and midterm durability of open surgical repair (OSR) as a salvage therapy for endoleaks after failed endovascular aneurysm repair (EVAR).

A single-center retrospective analysis was performed on 23 consecutive patients (21 males, 2 females; mean age 65.6±10.6 years) undergoing OSR for persistent endoleaks at ****** between May 2018 and July 2023. Endoleak subtypes included Type I (n=7), Type II (n=14), Type III (n=1), and Type IV (n=1). Primary endpoints were 30-day mortality and major adverse events (MAEs), with secondary endpoints encompassing 3-year survival and reintervention rate.

The thirty-day mortality of the cohort reached 13.0% (3/23), attributed to pulmonary infection (n=1), circulatory collapse (n=1), and septic shock (n=1). Notably, 34.8% (8/23) developed pulmonary complications, while 21.7% (5/23) experienced acute kidney injury. At a median follow-up of 30.6 months (IQR 25.4-38.9), the 3-year overall survival rate was 86.9%. No aorta-related deaths occurred during follow-up; only one patient (4.3%) required secondary intervention for distal iliac artery redilation.

OSR constitutes a definitive solution for endoleak management post-EVAR, demonstrating acceptable perioperative risk and durable midterm outcomes. Although pulmonary and renal complications remain noteworthy short-term concerns, the technique offers low reintervention rates and stable survival trajectories, particularly in the absence of aorta-related mortality.