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Eur J Vasc Endovasc Surg. 2013 May;45(5):457-64. doi: 10.1016/j.ejvs.2012.12.021. Epub 2013 Feb 17.

Delayed open conversion after endovascular abdominal aortic aneurysm: device-specific surgical approach.

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1
Vascular Surgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.

Abstract

OBJECTIVES:

Despite several advances in endoluminal salvage for failed endovascular abdominal aortic repair (EVAR), in our experience an increasing number of cases necessitate delayed open conversion (dOC).

METHODS:

EVAR patients requiring delayed (>30 days) conversion were prospectively collected in a computerized database including demographics, details of aortoiliac anatomy, procedural and clinical success, and postoperative complications.

RESULTS:

Between 2005 and 2011, 54 patients were treated for aortic stent-graft explantation. Indications included 34 type I and III endoleaks, 13 type II endoleaks with aneurysm growth, 4 cases of material failures, and 3 stent-graft infections. All fit-for-surgery patients with type I/III endoleak underwent directly dOC. Different surgical approaches were used depending on the type of stent-graft. Overall 30-day mortality was 1.9%. Overall morbidity was 31% mainly due to acute renal failure (13 cases). Mean hospitalization was 6 days (range, 5-27 days). Overall survival at mean follow-up of 19 months was 78%.

CONCLUSIONS:

In recent years, the use of EVAR has increased dramatically, including in young patients regardless of their fitness for open repair. dOC after endovascular abdominal aortic aneurysm seems to be a lifesaving procedure with satisfactory initial and mid-term results.

PMID:
23422797
DOI:
10.1016/j.ejvs.2012.12.021
[Indexed for MEDLINE]
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