Key result
Late open conversion after failed EVAR yields up to ~80% long-term survival despite significant complication risks.
Why the study?
The number of late open conversions after endovascular aneurysm repair has grown over the last decades.
Late open conversion after EVAR is associated with significant morbidity and mortality, particularly in urgent cases or when suprarenal clamping is required, though 5-year survival can reach up to 80%.
Stricter post-EVAR surveillance may curb rising LOC in non-compliant high-risk patients; leaves open optimal prevention strategies.
The number of late open conversion (LOC) after endovascular aneurysm repair (EVAR) grew over the last decades. LOC patients are frequently non-compliant to follow-up protocols, females with large aneurysms, and/or high-risk patients with an endograft frequently deployed outside instruction for use. The main indications for LOC are endoleaks (mostly type Ia and II), but also aortic rupture and infection. LOC is generally performed after one or more endovascular secondary procedure; urgent LOC represents an important portion of post-EVAR explantations. All types of endograft have been removed. Surgical approach is transperitoneal (midline or bilateral subcostal incision), retroperitoneal or thoracoabdominal, according to clinical factors or surgeon’s experience and preference. Suprarenal clamping is associated with higher rates of renal insufficiency, visceral complications and mortality. Arterial reconstruction can be in-situ (aorto-aortic, aorto-bi-iliac, aorto-bifemoral; Dacron graft) or extra-anatomical (mainly axillo-bi-femoral bypass). Thirty-day mortality is higher in case of urgent LOC, infection, advanced age and chronic obstructive pulmonary disease. Possible 30-day complications are those of open abdominal aortic repair, with a higher risk of reoperation for bleeding. Suprarenal clamping has a higher tendency to develop renal injury and visceral ischemia, while prolonged hospital stay is due to respiratory and renal complications. During follow-up (mean at least 19 up to 51 months), estimated survival is from 60% to 89% at 6 months/1-year and from 45% to 80% at 5 year and frequent late complications are infection, aneurysm degeneration, aorto-enteric fistula, acute myocardial infarction and stroke.
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Perini et al. (2019) conducted a review in Failed endovascular aneurysm repair (EVAR) requiring late open conversion. Late open conversion (LOC) was evaluated on Estimated survival. Late open conversion after failed EVAR has an estimated survival of 60% to 89% at 6 months to 1 year, and 45% to 80% at 5 years, with significant risks of perioperative and late complications.
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