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Eur J Vasc Endovasc Surg. 2006 Feb;31(2):136-42. Epub 2005 Dec 15.

Conversion to open repair after endografting for abdominal aortic aneurysm: causes, incidence and results.

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1
Department of Vascular Surgery, University of Perugia, Azienda Ospedaliera di Perugia, Perugia, Italy.

Abstract

OBJECTIVE:

To evaluate frequency, causes and results of conversion to Open repair (OR) after endovascular repair (EVAR) in a single centre during an 8-year period.

DESIGN:

Six hundred and forty-nine consecutive patients undergoing EVAR were followed up prospectively for endograft-related complications.

OUTCOMES:

Early conversion was any OR during or within 30 days from the primary EVAR. Late conversion was any OR with removal of the endograft after 30 days since a completed EVAR procedure.

RESULTS:

Median patient follow-up was 38 months (1-93 months). Conversion to OR was performed in 38 patients; nine early and 29 late. Most (7/9) early conversions were due to extensive vessel calcification. Peri-operative mortality was 22% (2/9). Late conversions occurred at a median of 33 months after primary EVAR: 29 were elective and 4 urgent. During the same interval, 79 secondary endovascular interventions were performed, 7 of which failed. The risk of conversion to OR was 9% at 6 years. At multivariate logistic regression analysis, no single factor (short, large or angulated neck, suprarenal fixation, large pre-operative diameter, iliac aneurysms, ASA score risk) was associated with the risk of late failure requiring conversion to OR.

CONCLUSION:

The risk of death after early conversion should be recognized, to avoid forcing morphological indications for primary EVAR. Occurrence of late conversion after EVAR is not negligible, affecting almost 1 out of 10 patients after 6 years. In the presence of an expanding aneurysm after EVAR, especially after a failed secondary endovascular correction, an aggressive attitude in fit patients allows outcomes at similar to those of primary OR.

PMID:
16359884
DOI:
10.1016/j.ejvs.2005.09.016
[Indexed for MEDLINE]
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