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Late open conversion after endovascular abdominal aortic repair: a 20-year experience

 Hyun-Chel Joo  ;  Seung-Hyun Lee  ;  Byung-Chul Chang  ;  Sak Lee  ;  Kyung-Jong Yoo  ;  Young-Nam Youn 
 Journal of Cardiovascular Surgery, Vol.60(1) : 73-80, 2019 
Journal Title
Issue Date
Aged ; Aortic Aneurysm, Abdominal/surgery* ; Blood Vessel Prosthesis Implantation/adverse effects ; Blood Vessel Prosthesis Implantation/methods* ; Conversion to Open Surgery*/mortality ; Emergencies ; Endoleak/etiology ; Endoleak/surgery ; Endovascular Procedures/adverse effects* ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Length of Stay ; Male ; Middle Aged ; Prosthesis Design ; Prosthesis Failure ; Retrospective Studies ; Stents
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.
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1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0002-0311-6565
Chang, Byung Chul(장병철)
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
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