Objectives: Open procedures are often required for late complications after endovascular abdominal aortic aneurysm repair (EVAR). Our aim is to describe the indications for open interventions and their post-operative outcomes, and to specifically examine our experience with limited conversions in which problematic endoleaks are targeted without endograft explantation. Methods: We reviewed patients from 2002-2017 who underwent any surgical abdominal aortic operation after a previous EVAR. Baseline characteristics, pre-operative imaging, procedural details, and post-operative outcomes were reviewed. The primary endpoint was 30-day mortality. Results: 102 patients underwent open conversion 3.8 ± 3.1 years after EVAR. The numbers increased significantly in recent years, with 18 cases performed in 2016. 48.5% of patients had undergone 1.9 ± 1.0 prior endovascular interventions. The indication for surgical conversion was an endoleak in 85 patients and infection in 15. One patient had a limb occlusion and another a proximal aneurysm. 30-day mortality was 6.2% in 65 patients treated electively for endoleak but higher in 20 ruptures (40.0%) and 15 infections (40.0%). In a multivariate logistic regression model, independent predictors of 30-day mortality were rupture (OR 6.70, 95% CI 1.75-25.60, P = .005), endograft infection (OR 8.48, 95% CI 1.99-36.20, P = .004), and use of a supraceliac clamp (OR 4.80, 95% CI 1.47-15.66, P = .009). Transient acute kidney injury (12.8%) and prolonged intubation (11.8%) were the most common post-operative complications. In 65 patients treated for endoleak without rupture, 37 underwent endograft explantation while 28 had a graft-preserving (GP) intervention (branch vessel ligation for type II endoleak in 26, external banding of the aneurysm neck for type IA endoleak in 8). Mortality was 8.1% when the endograft was explanted and 3.6% when it was not (P = .63). Over 3.0 ± 3.5 years of follow-up, there was one re-intervention after endograft explantation (for rupture secondary to type IB endoleak) and

Objective: Open procedures are often required for late complications after endovascular aortic aneurysm repair (EVAR). Our aim was to describe the indications for open interventions and their postoperative outcomes and to identify factors that can predict mortality after open conversion. Methods: We reviewed patients from 2002 to 2017 who underwent any surgical abdominal aortic operation after a previous EVAR. Baseline characteristics, preoperative imaging, procedural details, and postoperative outcomes were reviewed. The primary end point was 30-day mortality. Results: There were 81 patients who underwent open conversion 3.9 6 3.3 years after EVAR. The numbers increased significantly in recent years, with 18 cases performed in 2016 (Fig); 44.7% of patients had undergone 1.9 6 1.0 prior endovascular interventions. The indication for surgical conversion was an endoleak in 66 patients (81.5%) and infection in 13 (16.1%). One patient had a limb occlusion and another a proximal aneurysm. The 30-day mortality was 21.0% and was highest in 17 ruptures (41.2%) and 13 infections (46.2%). In a multivariate logistic regression model, independent predictors of 30-day mortality were rupture (odds ratio [OR], 6.16; 95% confidence interval [CI], 1.41-26.98; P ¼ .02), endograft infection (OR, 11.64; 95% CI, 2.38-56.90; P ¼ .002), and use of a supraceliac clamp (OR, 4.70; 95% CI, 1.26-17.49; P ¼ .02). Transient acute kidney injury (15.6%) and prolonged intubation (11.7%) were the most common postoperative complications. In 49 patients treated for endoleak without rupture, 31 underwent endograft explantation; 18 had a limited intervention (branch vessel ligation for type II endoleak in 16, external banding of the aneurysm neck for type Ia endoleak in 7). Mortality was 6.5% when the endograft was explanted and 5.6% when it was not (P ¼ 1.00). During 2.3 6 2.9 years of follow-up, only one reintervention was required (proximal cuff placement for new type Ia endoleak after branch vessel ligation). Survival was 91.0% at 1 year and 81.7% at 5 years. Conclusions: Open conversion is playing an increasing role in the management of late EVAR complications. In patients without rupture or infection, both limited conversions and total explantation have a low mortality and good long-term durability.

Objectives To estimate the prevalence of daytime sleepiness and circadian preferences, and to examine the extent to which caffeine consumption and Khat (a herbal stimulant) use are associated with daytime sleepiness and evening chronotype among Ethiopian college students. Methods A cross-sectional study was conducted among 2,410 college students. A self-administered questionnaire was used to collect information about sleep, behavioral risk factors such as caffeinated beverages, tobacco, alcohol, and Khat consumption. Daytime sleepiness and chronotype were assessed using the Epworth Sleepiness Scale (ESS) and the Horne & Ostberg Morningness /Eveningness Questionnaire (MEQ), respectively. Linear and logistic regression models were used to evaluate associations. Results Daytime sleepiness (ESS≥10) was present in 26% of the students (95% CI: 24.4–27.8%) with 25.9% in males and 25.5% in females. A total of 30 (0.8%) students were classified as evening chronotypes (0.7% in females and 0.9% in males). Overall, Overall, Khat consumption, excessive alcohol use and cigarette smoking status were associated with evening chronotype. Use of any caffeinated beverages (OR=2.18; 95%CI: 0.82–5.77) and Khat consumption (OR=7.43; 95%CI: 3.28–16.98) increased the odds of evening chronotype. Conclusion The prevalence of daytime sleepiness among our study population was high while few were classified as evening chronotypes. We also found increased odds of evening chronotype with caffeine consumption and Khat use amongst Ethiopian college students. Prospective cohort studies that examine the effects of caffeinated beverages and Khat use on sleep disorders among young adults are needed.

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Even with prompt revascularization and despite the chosen treatment modality, AAO carries high risk of mortality and numerous life-threatening complications. Older patients presenting with elevated lactate levels, motor deficit, and bilateral internal iliac artery occlusions are at the highest risk of perioperative mortality. These factors may aid in risk stratification and managing expectations in this critically ill population.