OBJECTIVE: To evaluate frequency, causes and results of conversion to Open repair (OR) after endovascular repair (EVAR) in a single centre during an 8-year period. DESIGN: Six hundred and forty-nine consecutive patients undergoing EVAR were followed up prospectively for endograft-related complications. OUTCOMES: Early conversion was any OR during or within 30 days from the primary EVAR. Late conversion was any OR with removal of the endograft after 30 days since a completed EVAR procedure. RESULTS: Median patient follow-up was 38 months (1-93 months). Conversion to OR was performed in 38 patients; nine early and 29 late. Most (7/9) early conversions were due to extensive vessel calcification. Peri-operative mortality was 22% (2/9). Late conversions occurred at a median of 33 months after primary EVAR: 29 were elective and 4 urgent. During the same interval, 79 secondary endovascular interventions were performed, 7 of which failed. The risk of conversion to OR was 9% at 6 years. At multivariate logistic regression analysis, no single factor (short, large or angulated neck, suprarenal fixation, large pre-operative diameter, iliac aneurysms, ASA score risk) was associated with the risk of late failure requiring conversion to OR. CONCLUSION: The risk of death after early conversion should be recognized, to avoid forcing morphological indications for primary EVAR. Occurrence of late conversion after EVAR is not negligible, affecting almost 1 out of 10 patients after 6 years. In the presence of an expanding aneurysm after EVAR, especially after a failed secondary endovascular correction, an aggressive attitude in fit patients allows outcomes at similar to those of primary OR.
OBJECTIVE: To evaluate frequency, causes and results of conversion to Open repair (OR) after endovascular repair (EVAR) in a single centre during an 8-year period. DESIGN: Six hundred and forty-nine consecutive patients undergoing EVAR were followed up prospectively for endograft-related complications. OUTCOMES: Early conversion was any OR during or within 30 days from the primary EVAR. Late conversion was any OR with removal of the endograft after 30 days since a completed EVAR procedure. RESULTS: Median patient follow-up was 38 months (1-93 months). Conversion to OR was performed in 38 patients; nine early and 29 late. Most (7/9) early conversions were due to extensive vessel calcification. Peri-operative mortality was 22% (2/9). Late conversions occurred at a median of 33 months after primary EVAR: 29 were elective and 4 urgent. During the same interval, 79 secondary endovascular interventions were performed, 7 of which failed. The risk of conversion to OR was 9% at 6 years. At multivariate logistic regression analysis, no single factor (short, large or angulated neck, suprarenal fixation, large pre-operative diameter, iliac aneurysms, ASA score risk) was associated with the risk of late failure requiring conversion to OR. CONCLUSION: The risk of death after early conversion should be recognized, to avoid forcing morphological indications for primary EVAR. Occurrence of late conversion after EVAR is not negligible, affecting almost 1 out of 10 patients after 6 years. In the presence of an expanding aneurysm after EVAR, especially after a failed secondary endovascular correction, an aggressive attitude in fit patients allows outcomes at similar to those of primary OR.
Authors: Salvatore T Scali; Michael M McNally; Robert J Feezor; Catherine K Chang; Alyson L Waterman; Scott A Berceli; Thomas S Huber; Adam W Beck Journal: J Vasc Surg Date: 2014-03-27 Impact factor: 4.268
Authors: Salvatore T Scali; Adam W Beck; Catherine K Chang; Dan Neal; Robert J Feezor; David H Stone; Scott A Berceli; Thomas S Huber Journal: J Vasc Surg Date: 2015-11-21 Impact factor: 4.268
Authors: Klaas H J Ultee; Peter A Soden; Sara L Zettervall; Jeremy Darling; Hence J M Verhagen; Marc L Schermerhorn Journal: J Vasc Surg Date: 2016-07 Impact factor: 4.268