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J Vasc Surg. 2007 Oct;46(4):642-7. Epub 2007 Aug 30.

Acute and chronic open conversion after endovascular aortic aneurysm repair: a 14-year review.

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1
Division of Vascular Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA 90095, USA.

Abstract

OBJECTIVE:

This study reviewed outcomes of patients requiring surgical conversion after endovascular abdominal aortic aneurysm (AAA) repair.

METHODS:

Records for all patients undergoing open conversion after endovascular AAA repair were reviewed.

RESULTS:

From 1993 to 2006, 574 patients underwent endovascular repair for AAA. Seventeen patients, including three patients who underwent prior endovascular repair at other centers, required surgical conversion with complete (n = 9) or partial graft removal (n = 8). Five patients required immediate conversion (acute), and 12 underwent delayed conversion 4 to 72 months after endovascular repair. Indications for acute conversion were large type I endoleak (n = 3, 60%), including one patient with graft migration, and retroperitoneal bleeding (n = 2, 40%). Indications for chronic conversion were endoleak with increasing aneurysm size (n = 9, 75%), stent fracture without endoleak (n = 1, 8%), delayed retroperitoneal bleeding (n = 1, 8%), and infection (n = 1, 8%). Suprarenal aortic cross-clamping was required in two patients (12%), and endograft components were retained in eight (47%). An aortic occlusion balloon placed through the body of the existing endograft facilitated proximal control in three patients. There were two perioperative deaths in the acute conversion group (2/5; 40%) and none in the delayed conversion group (P = .04). Five-year actuarial survival was 71.9%. Mean follow-up was 41.6 +/- 32.2 months. Retained endovascular components in patients with partial graft removal remained stable during follow-up.

CONCLUSIONS:

Surgical conversion after endovascular AAA repair can be performed without suprarenal clamping in most patients. Endovascular aortic control with a balloon avoids suprarenal exposure. Partial endograft removal in selected patients facilitates open conversion and appears durable. Acute conversion is associated with increased mortality.

PMID:
17764870
DOI:
10.1016/j.jvs.2007.05.030
[Indexed for MEDLINE]
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