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Italian Journal of Vascular and Endovascular Surgery 2019 September;26(3):135-9

DOI: 10.23736/S1824-4777.19.01419-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Late open conversions after failed EVAR

Paolo PERINI , Claudio BIANCHINI MASSONI, Erica MARIANI, Rita M. D’OSPINA, Giulia ROSSI, Anna G. CARLI, Alberto BRAMUCCI, Matteo AZZARONE, Antonio FREYRIE

Division of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy



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.


KEY WORDS: Aortic aneurysm, abdominal; Conversion to open surgery; Endovascular procedures, complications

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