Key result
Late open conversion for managing endoleaks after endovascular aortic aneurysm repair achieved a 100% technical success rate with a 16.7% 30-day mortality in a small single-center cohort.
Why the study?
Despite the efficacy of endovascular approaches for secondary interventions post-EVAR, a small proportion of patients require open conversion procedures.
Observational (n=6)
No
Late open conversion post-EVAR is technically feasible with 100% success in this small series, though it carries significant mortality risk, particularly in urgent settings.
Late open conversion may be feasible for endoleak management post-EVAR; leaves open optimal patient selection and durability in larger prospective studies.
BACKGROUND/OBJECTIVES: Despite the efficacy of endovascular approaches for most secondary interventions post-endovascular aortic aneurysm repair (EVAR), a small proportion of patients need open conversion (OC) procedures. We shared our experience regarding patient outcomes after late OCs post-EVAR. We also performed a literature review of data published on this topic. PATIENTS, MATERIALS AND METHODS: Medical records of patients who underwent late OCs post-EVAR at a Public Hospital in Germany (2017-2019) were retrospectively analyzed. OC involved total or partial endograft removal followed by aortic reconstruction. Preoperative patients' characteristics, indications for OC, and intra-∕post-operative outcomes were assessed. Studies published in English (2014-2024) on OCs post-EVAR complications were descriptively analyzed. RESULTS: Six patients underwent late OCs throughout the study (males: 66.67%; age [mean±standard deviation]: 66.50±2.89 years). Grafts were excised after a median of 72 months (range: 24-132 months), with 2∕6 (33.33%) urgent removals and 4∕6 (66.67%) elective. 4∕6 (66.67%) patients underwent complete removal, and 2∕6 (33.33%) were partial. Clamping site was suprarenal in 3∕6 (50.00%) patients, supraceliac in 2∕6 (33.33%), and infrarenal in 1∕6 (16.67%). Technical success was 100%, with 32 minutes mean clamping time and 1.67 L blood loss. Median follow-up was 13 months. No aneurysm growth was observed, and implanted grafts functioned well. 1∕6 (16.67%) patients died during the postoperative intensive care unit stay. Seven studies were included in our review. The 30-day mortality post-OCs was 6.2-10.0% in elective setting and up to 40% in urgent. CONCLUSIONS: Late OC can be a reliable procedure for managing endoleak post-EVAR. Its success relies on accurate preoperative assessment and surgical expertise.
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Coman et al. (2025) conducted an observational in Endoleak after endovascular aortic aneurysm repair (EVAR) (n=6). Late open conversion was evaluated on Technical success. Late open conversion for managing endoleaks after endovascular aortic aneurysm repair achieved a 100% technical success rate with a 16.7% 30-day mortality in a small single-center cohort.
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