Key result
Late open conversion after EVAR was associated with 0% in-hospital mortality, though the seven-year all-cause mortality rate was 78.5%.
Why the study?
EVAR is associated with higher rates of reintervention compared to open repair, prompting investigation into early and mid-term outcomes of late open conversion including aneurysmorrhaphy.
What are the early and mid-term outcomes of late open conversion after endovascular abdominal aneurysm repair (EVAR)?
Cohort (n=29)
No
What are the early and mid-term outcomes of late open conversion after endovascular abdominal aneurysm repair (EVAR)?
Late open conversion after EVAR appears safe with no in-hospital mortality, though long-term all-cause mortality in this cohort was high.
Late open conversion after EVAR may be feasible in select cases; leaves open optimal timing, technique, and long-term durability in prospective data.
BackgroundEndovascular abdominal aneurysm repair (EVAR) offers a less invasive approach to treating abdominal aortic aneurysms (AAA) compared to open repair. However, EVAR is associated with higher rates of reintervention. This study investigates the early and mid-term outcomes of patients who underwent late open conversion including aneurysmorrhaphy after EVAR at our institution.MethodsWe conducted a retrospective cohort study of 29 patients who underwent late open conversion for AAA dilatation after EVAR between April 2015 and March 2022 at Chiba University Hospital. Surgical strategies included an artificial graft replacement for Type Ia endoleak (EL), Type III EL from stent graft main body, ruptured cases, and aneurysmorrhaphy with branch ligation for Type II EL.ResultsThe average time from EVAR to open conversion was 4.1 ± 2.3 years. There have been no reported cases of in-hospital mortality to date. Aneurysmorrhaphy demonstrated shorter operative times (239 ± 65 min) and lower red blood cell transfusion volumes (2.7 ± 4.2 units) compared to graft replacement. Postoperative complications included spinal cord ischemia in one patient and three patients requiring reintervention due to persistent or new ELs, who underwent angiography. The seven-year all-cause mortality rate was 78.5%. Among cases that underwent aneurysmorrhaphy, postoperative computed tomography scans showed a reduction in the maximum aortic diameter from 65 ± 6 mm preoperatively to 42 ± 10 mm postoperatively and 36 ± 11 mm at follow-up.ConclusionsLate open conversion including aneurysmorrhaphy after EVAR appears to be safe and effective, with no in-hospital mortality and low complication rates. Careful preoperative planning and appropriate surgical techniques are essential for optimizing outcomes.
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Nishiori et al. (2025) conducted a cohort in Abdominal aortic aneurysm (AAA) dilatation after EVAR (n=29). Late open conversion was evaluated on In-hospital mortality. Late open conversion after EVAR was associated with 0% in-hospital mortality, though the seven-year all-cause mortality rate was 78.5%.
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