Key result
Urgent late open conversion after EVAR is linked to ~10-fold higher 30-day mortality than elective conversion.
Why the study?
Complications after EVAR, such as endoleaks and graft infections, may require late open conversion, prompting an evaluation of its incidence, outcomes, and contributing factors.
Meta-Analysis
Effect estimate: 10 times higher
Absolute Event Rate: 28.3% vs 2.8%
Late open conversion after EVAR occurs in approximately 5.3% of cases, with urgent conversions carrying a 10-fold higher mortality risk than elective procedures, emphasizing the critical need for vigilant long-term surveillance.
Urgent late open conversion after EVAR carries high mortality; supports enhanced surveillance to enable elective conversion when indicated.
Endovascular aneurysm repair (EVAR) is a preferred treatment for abdominal aortic aneurysms, though it comes with complications such as endoleaks and graft infections that may necessitate late open conversion (LOC). This systematic review and meta-analysis, drawing on studies from PubMed/MEDLINE, Embase, and the Cochrane Database of Systematic Reviews, aimed to evaluate the incidence, outcomes, and factors leading to LOC after EVAR. The analysis of 11 selected studies revealed a 5.3% incidence of LOC, with a patient cohort predominantly male (79%) and an average age of 73.5 years. The interval between initial EVAR and LOC was 35.1 months on average, with the Excluder device most frequently necessitating LOC. A notable 68% of endovascular salvage attempts before LOC failed. The study highlighted rupture and type I endoleak as the primary reasons for urgent LOC, which exhibited a 10-fold higher mortality rate compared to elective LOC. Elective LOC procedures had a 30-day mortality rate similar to primary elective open aneurysm repairs. These findings underscore the importance of vigilant post-EVAR patient monitoring and suggest that the methodological quality of underlying research should be considered in interpreting these results.
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Alqahtani et al. (2024) conducted a meta-analysis in Abdominal aortic aneurysm post-endovascular aneurysm repair. Urgent late open conversion vs. Elective late open conversion was evaluated on 30-day mortality (10 times higher). Urgent late open conversion after endovascular aneurysm repair was associated with a 10-fold higher 30-day mortality rate (28.3%) compared to elective late open conversion (2.8%).
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