Late open conversion after endovascular abdominal aortic aneurysm repair: experience of three-high volume centers

Davidović, Lazar; Palombo, Domenico; Třeška, Vladislav; Sladojević, Miloš; Končar, Igor; Houdek, Karel; Spinella, Giovanni; Zlatanović, Petar; Pane, Bianca

doi:10.23736/s0021-9509.19.10972-x

Cited by 14 publications

(10 citation statements)

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“…[9] In a single-center cohort evaluating LOSC in the urgent setting, with high proportion of ruptured cases (57%), Perini et al presented similar results, i.e., the mortality rate was 33% [10,11] Three important technical elements of LOSC are: surgical approach, the level of proximal aortic cross-clamping (ACC) and the procedure with stent-graft. [5] We advocate transperitoneal approach through midline laparotomy, since this provides adequate proximal and distal bleeding control, and enables fast cardiopulmonary reanimation if necessary.…”

Section: Discussionmentioning

confidence: 99%

“…In the previous multicentric study we already reported that morbidity and mortality rates for LOSC after EVAR are generally higher than in standard open elective or semi-elective circumstances. [4,5] Currently, insufficient data are available in the latest European Society for Vascular and Endovascular Surgery (ESVS) Guidelines on the Management of Abdominal Aorto-iliac Aneurysms to recommend a particular strategy when performing LOSC in RAAA setting, and surgeon's preference still plays a major role. [6] That is why the goal of this paper is to present the results and technical considerations from high-volume center when performing late open surgical conversion (LOSC) after EVAR in RAAA patients, that might help vascular surgeons when dealing with this challenging condition.…”

Section: Introductionmentioning

confidence: 99%

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Open surgical conversion and management of patients with ruptured abdominal aortic aneurysm after previous endovascular aneurysm repair

Marković

Zlatanović²,

Dimić

et al. 2022

Srp Arh Celok Lek

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Introduction/Objective. The goal of this paper is to present the results and technical considerations from high-volume center when performing late open surgical conversion (LOSC) after endovascular aneurysm repair (EVAR) in ruptured abdominal aortic aneurysm (RAAA) patients. Methods: This was a single center retrospective study. LOSC was performed whenever eventual endovascular reintervention failed, was not feasible due to hostile anatomy and unavailability of specific endograft materials, or when patient was hemodinamically unstable necessitating emergent surgery. Results. All previously implanted EVARs had bimodular configuration with suprarenal fixation. Total endograft explantation was performed in 40% of patients. Hospital mortality was 20%. Both patients who died had total endograft explantation with supracoelic clamp lasting more than 30min. Thirty-day mortality was 30%, with one more patient who died from pulmonary embolism after hospital discharge and two hospital deaths were due to myocardial infarction. Conclusion. LOSC due to RAAA after previous EVAR carries greater mortality for the patient, suggesting multifactorial impacts on the outcome. The appropriate choice of surgical method and technical success are of ultimate importance, with total graft explantation having negative impact on patient?s survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Open surgical conversion and management of patients with ruptured abdominal aortic aneurysm after previous endovascular aneurysm repair

Marković

Zlatanović²,

Dimić

et al. 2022

Srp Arh Celok Lek

Self Cite

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“…(11) To be more precise, the reported single-center late open surgical conversion (LOSC) rates after EVAR ranged from 0.67% to even 22.8%. (12) Despite advances in the OR of descending thoracic aneurysms during the past few decades, TEVAR is associated with a significantly lower 30-day mortality, as well as with a significantly lower incidence of spinal cord ischemia, respiratory failure and renal insufficiency. However, there is no difference in long-term survival after the second year of the follow-up.…”

Section: Degenerative Aortic Aneurysms With Favorable Anatomymentioning

confidence: 99%

“…(14) However, LOSC after both EVAR and TEVAR is associated with significantly higher perioperative mortality and other very serious perioperative complications in comparison with primary OR of TAA and TAAA. (12,14,37)…”

Section: Abdominal Aortic Aneurysms With Associated Accessory Renal A...mentioning

confidence: 99%

Open aortic aneurysm repair in the endovascular era

Davidović,

Matejević,

Kostić

2022

Medicinska istraživanja

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Open repair (OR) of aortic aneurysms is still relatively mutilating and risky in older and high-risk patients. Since the introduction of EVAR, a significantly lower perioperative mortality has been noted. Apart from advantages, endovascular treatment has some disadvantages as well, due to which OR still has a very important role in the endovascular era. In a vast majority of the patients younger than 65, with good overall condition, long life expectancy and favorable anatomy, as well as in patients with hostile aneurysm neck anatomy, heritable connective tissue disorders, complete thrombosis of abdominal aortic aneurysm (AAA) and potent accessory renal arteries, OR is the first treatment option in comparison with the endovascular treatment. EVAR is recommended as the first treatment option in patients with inflammatory aneurysms and OR should be considered only in better shaped patients with inflammatory AAA and significant hydronephrosis. Late open surgical conversion (LOSC) is a noted event after endovascular treatment and is associated with a significantly higher perioperative mortality and other serious perioperative complications compared to primary OR. Multicenter randomized controlled trials (RCT) did not find a significant difference regarding 30-day mortality between open and endovascular repair of ruptured AAA. However, not all ruptured AAA are suitable for endovascular repair. In a hemodynamically unstable patients, when there is no time for MDCT angiography, EVAR is not possible, and OR is the only option. The incidence of abdominal compartment syndrome after OR is significantly lower in comparison with EVAR thanks to surgical evacuation and drainage of retroperitoneal hematoma. The improvement of the results of aortic aneurysm treatment largely depends on the volume of yearly aortic operations. Having in mind all the mentioned advantages and disadvantages of OR and endovascular repair, we can conclude that in high volume centers, younger generations of vascular surgeons should be educated in standard and complex open aortic surgery.

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“…4,5 The incidence of OSC is increasing over the time with rates varying between 0.67% and 22.8% in some series. 6 Plenty literature 4 in recent years has described technical outcomes after open conversion: surgical approach (transperitoneal or retroperitoneal), clamp location, type of explantation (partial or complete), and postoperative complications. However, there is sparse information about the preoperative factors that might lead to OSC, specifically the relationship between devices Instructions For Use (IFU) compliance, endovascular reintervention, device degenerative phenomena, 7 and their influence to the final OSC indication.…”

Section: Introductionmentioning

confidence: 99%

Multicenter Comparative Analysis of Late Open Conversion in Patients With Adherence and Nonadherence to Instructions for Use Endovascular Aneurysm Repair

et al. 2022

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Purpose: The widespread adoption of endovascular aneurysm repair (EVAR) as preferred treatment modality for abdominal aortic aneurysm (AAA) has enlarged the number of patients needing open surgical conversion (OSC). The relationship between adherence to Instructions For Use (IFU) and EVAR long-term outcomes remains controversial. The aim of this study is to compare preoperative differences and postoperative outcomes between EVAR patients not adjusted to IFU and adjusted to IFU who underwent OSC. Methods: This multicenter retrospective study reviewed 33 explanted EVARs between January 2003 and December 2019 at 14 Vascular Units. Patients were included if OSC occurred >30 days after implantation and excluded if explantation was performed to treat an endograft infection, aortic dissection, or traumatic transections. Variables analyzed included baseline characteristics, adherence to IFU, implant and explant procedural details, secondary reinterventions, and postoperative outcomes. Results: Fifteen explanted patients (15/33, 45.5%) were identified not accomplished to IFU (out-IFU) at initial EVAR vs 18 explanted patients adjusted (in-IFU). During follow-up, a mean of 1.73±1.2 secondary reinterventions were performed, with more type I endoleaks treated in the subgroup out-IFU: 16.7% vs 6.3% in-IFU patients and more type III endoleaks (8.3% vs 0%). Patients out-IFU had shorter mean interval from implant to explant: 47.60±28.8 months vs 71.17±48. Type II endoleak was the most frequent indication for explantation. Low-flow endoleaks (types II, IV, V) account for 44% of indications for OSC in subgroup of patients in-IFU, compared with 13.3% in patients out-IFU and high-flow endoleaks (types I and III) were the main indication for patients out-IFU (33.3% vs 16.7% in-IFU). Total endograft explantation was performed in 57.5% of cases (19/33) and more suprarenal clamping was required in the subgroup out-IFU. Overall, 30-day mortality rate was 12.1% (4/33): 20% for patients out-IFU and 5.6% in-IFU. Conclusions: In our experience, type II endoleak is the most common indication for conversion and differences have been found between patients treated outside IFU with explantation taking place earlier during follow-up, mainly due to high-flow endoleaks and with higher mortality in comparison with patients adjusted to IFU. Ongoing research is required to delve into these differences.

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Late open conversion after endovascular abdominal aortic aneurysm repair: experience of three-high volume centers

Cited by 14 publications

References 50 publications

Open surgical conversion and management of patients with ruptured abdominal aortic aneurysm after previous endovascular aneurysm repair

Open surgical conversion and management of patients with ruptured abdominal aortic aneurysm after previous endovascular aneurysm repair

Open aortic aneurysm repair in the endovascular era

Multicenter Comparative Analysis of Late Open Conversion in Patients With Adherence and Nonadherence to Instructions for Use Endovascular Aneurysm Repair

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