Hyun-Chel Joo1, Seung-Hyun Lee1, Byung-Chul Chang1, Sak Lee1, Kyung-Jong Yoo1, Young-Nam Youn2. 1. Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. 2. Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea - ynyoun@yuhs.ac.
Abstract
BACKGROUND: With the increasing use of endovascular aortic repair, secondary interventions after aortic stent grafting remain a concern. We retrospectively reviewed open conversion cases with complications following endovascular abdominal aortic repair (EVAR). METHODS: EVAR due to infra-renal abdominal aortic aneurysm (AAA) was performed in 566 patients between January 1994 and May 2015. A retrospective review of EVAR requiring late open conversion (>1 month after implant) was conducted. Patient demographics, reasons for conversion, operative techniques, operative outcomes, and late survival were reviewed. RESULTS: Thirty of these patients (5.3%) required late conversion to open repair. The median interval to open conversion after EVAR was 48.6 months (range: 2-190 months). Indications of open conversion included type I endoleak (N.=10), stent fracture (N.=4), type V endoleak (N.=4), stent graft infection (N.=4), stent limb obstruction (N.=3), stent migration (N.=3), and type II endoleak (N.=2). Twenty-four operations were elective, and six operations (20%) were emergent due to aneurysm rupture. Compete endograft removal was performed in 14 patients (46.6%) and 16 endografts were partially left in situ. The hospital mortality rate was 10% (3/30) overall, 33.3% in the emergency group and 0% the elective group (P=0.03). Overall survival rate at a mean follow-up of 35 months was 80.7%, with a tendency towards lower survival rate after emergency compared with elective open conversion (89.3% vs. 44.4%; P=0.06). CONCLUSIONS: Open conversion due to late complications after EVAR seems to be a lifesaving procedure with acceptable initial and mid-term outcomes. Elective conversion has better outcomes compared to those in an emergency setting. Therefore, lifelong surveillance is warranted, and an early decision for open conversion, if indicated, is necessary to achieve the best outcomes.
BACKGROUND: With the increasing use of endovascular aortic repair, secondary interventions after aortic stent grafting remain a concern. We retrospectively reviewed open conversion cases with complications following endovascular abdominal aortic repair (EVAR). METHODS: EVAR due to infra-renal abdominal aortic aneurysm (AAA) was performed in 566 patients between January 1994 and May 2015. A retrospective review of EVAR requiring late open conversion (>1 month after implant) was conducted. Patient demographics, reasons for conversion, operative techniques, operative outcomes, and late survival were reviewed. RESULTS: Thirty of these patients (5.3%) required late conversion to open repair. The median interval to open conversion after EVAR was 48.6 months (range: 2-190 months). Indications of open conversion included type I endoleak (N.=10), stent fracture (N.=4), type V endoleak (N.=4), stent graft infection (N.=4), stent limb obstruction (N.=3), stent migration (N.=3), and type II endoleak (N.=2). Twenty-four operations were elective, and six operations (20%) were emergent due to aneurysm rupture. Compete endograft removal was performed in 14 patients (46.6%) and 16 endografts were partially left in situ. The hospital mortality rate was 10% (3/30) overall, 33.3% in the emergency group and 0% the elective group (P=0.03). Overall survival rate at a mean follow-up of 35 months was 80.7%, with a tendency towards lower survival rate after emergency compared with elective open conversion (89.3% vs. 44.4%; P=0.06). CONCLUSIONS: Open conversion due to late complications after EVAR seems to be a lifesaving procedure with acceptable initial and mid-term outcomes. Elective conversion has better outcomes compared to those in an emergency setting. Therefore, lifelong surveillance is warranted, and an early decision for open conversion, if indicated, is necessary to achieve the best outcomes.
Authors: Abhisekh Mohapatra; Darve Robinson; Othman Malak; Michael C Madigan; Efthimios D Avgerinos; Rabih A Chaer; Michael J Singh; Michel S Makaroun Journal: J Vasc Surg Date: 2018-12-21 Impact factor: 4.268