Key result
Partial endograft removal under infrarenal clamping is the preferred open conversion for post-EVAR type II endoleak.
Why the study?
The effectiveness of endovascular reinterventions for aneurysm sac enlargement due to type II endoleak following EVAR remains questionable, necessitating review of open surgical conversion strategies.
What is the most appropriate open surgical conversion strategy for treating sac enlargement due to type II endoleaks following EVAR?
What is the most appropriate open surgical conversion strategy for treating sac enlargement due to type II endoleaks following EVAR?
For patients requiring open surgical conversion due to persistent type II endoleak after EVAR, partial endograft removal under infrarenal clamping appears to be the most appropriate strategy.
Supports partial endograft removal under infrarenal clamping for type II endoleak conversions; leaves open need for prospective validation.
An aneurysm sac enlargement caused by type II endoleak (T2EL) following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms may cause serious complications such as rupture. Consequently, methods that preoperatively prevent or postoperatively treat T2EL have been employed. When significant aneurysm enlargement occurs due to persistent T2EL, embolization is first performed through several access points. However, although these endovascular reinterventions have a high technical success rate and are safe, their effectiveness remains questionable. When such endovascular procedures fail to stabilize sac enlargement, open surgical conversion (OSC) becomes the last-resort treatment option. We review several strategies of OSC for the repair of T2EL following EVAR. Among the three main OSC procedures, namely, complete endograft removal, partial endograft removal, and complete endograft preservation, partial endograft removal under infrarenal clamping was considered the most appropriate owing to its less invasiveness and durability.
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Onitsuka et al. (2023) conducted a review in Sac enlargement due to type II endoleaks following endovascular aneurysm repair (EVAR). Open surgical conversion (OSC) was evaluated. Partial endograft removal under infrarenal clamping is considered the most appropriate open surgical conversion strategy for sac enlargement due to type II endoleaks following EVAR.
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