CASE REPORTS   

Chirurgia 2011 December;24(6):327-31

Copyright © 2012 EDIZIONI MINERVA MEDICA

language: English

Technical considerations and operative aspects of late conversion of endoluminal stent-grafts

Thomas S. ¹, Vijayan V. ¹, Norman P. ³, Mwipatayi B. P. ^{1, 2}

¹ Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia 2 School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, Western Australia, 3Department of Vascular Surgery, Fremantle Hospital, Perth, Australia

We present our experience with late abdominal aortic stent-graft conversion to open repair. In particular, the indications for conversion, operative strategies and a review of the pertinent literature. A retrospective analysis of a series of open conversions after endoluminal repair of abdominal aortic aneurysm (AAA), conducted at Royal Perth Hospital and Hollywood Hospital, Western Australia over a 4 year period. Six patients had late open conversion of their endoluminal stent-graft repair. Two patients presented emergently with aneurysm sac rupture secondary to endoleak. Elective conversion for type IV endoleak was performed in two patients. Two patients had graft removal for bilateral limb occlusion. Surgery was challenging and complete graft excision was performed when possible with hybrid grafting techniques utilised after excision of a portion of the endograft. Anastomotic techniques included suture pledgets and graft plugs to strengthen anastomoses particularly at the proximal aortic anastomosis. Five patients recovered from their procedure to be discharged within two weeks of operation. One patient died in the early postoperative period. Late conversion of endoluminal abdominal aortic stent-grafts is not common and can be technically challenging. A variety of techniques can be chosen to deal with the complex anatomical variations.