Late conversion of aortic stent grafts

Abstract

Elective EVAR conversion, although technically challenging may be done with mortality similar to primary open repair. Mortality for conversion for infected grafts and ruptured aneurysms remains high. EVAR is associated with continued risk of conversion, and surveillance may identify late complications that require removal, justifying lifelong monitoring. Aggressive management of late complications and elective conversion may minimize the mortality associated with this procedure.

Late conversion of endovascular to open repair of abdominal aortic aneurysms

“…2 Indications for late conversion include endoleaks not amenable to endovascular treatment, endograft thrombosis, endograft infection or migration and aneurysm rupture. There are also several specific technical aspects of endograft explantation or preservation that need to be considered.…”

Primary Absence of Type II Endoleak is A Positive Prognostic Factor against the Risk of Late Conversion of EVAR for AAA

“…In the randomized EVAR-1 trial, the rate of late conversion (beyond the initial 30 postoperative days) to open repair was 2.6%, with a mean delay of 3.3 years after first repair [1]. Late conversion has been reported in literature as the follow up to 9% of EVAR [6]: our conversion rate (5.58%) falls within that range.Data emerging from our series suggest that age, gender, common atherogenic risk factors of the patients, as well as diameter of the aneurysm and type of endograft proximal fixation, do not significantly affect the post-operative outcome. The presence of type II endoleak at the first post-operative control seems to be related with late adverse outcome after EVAR (a statistically significant difference between group 3 and group 1 and 2 is observed).…”

Open Reintervention for Aneurysmal Sac Enlargement after EVAR

“…Therefore, direct clamping of these relatively stiff endoprostheses can lead to the risk of insufficient aortic control and damage to the aortic tissues if the supra-renal bare metal stent or fixation barbs tear the aorta. 5) Although "the clamp and pull" complete endograft extraction approach was suggested by several surgeons, 6,7) this is considered to be a very hazardous approach because of the existence of transrenal fixated endografts as the bare metal stent becomes incorporated into the juxtrenal aortic lining with a layer of neointima. 8) Therefore, endograft extraction using infection.…”

“…However, they emphasized these patients should receive close and frequent surveillance because future complications of remaining EVAR elements remain a possibility, and strongly suggested complete removal of the endograft should be the goal of procedure. 6) Considering technical difficulties in complete removal of the endoprosthesis and uncertainties in terms of the long term durability of incomplete preservation of the stent graft, we reported in 2012 modified open repair for aneurysmal sac enlargement after EVAR as one of the possible methods of completely preserving the endograft. 4) One of the most beneficial points of this procedure is the avoidance of aortic cross clamping, which prevents the need for systemic heparinization and therefore decreases the amount of surgical site bleeding.…”

“…However, it is important to note that further close and regular surveillance is necessary to establish if the long-term results of this technique are superior to that of other reported surgical options. [5][6][7][8][9][10][11] …”