Highlights
- •Late open conversion with endograft preservation is associated with good short-term outcome.
- •Late open conversion with endograft preservation sometimes results in sac re-enlargement in the mid-term period.
- •Sac wrapping technique with bio-prosthetic materials is a feasible way to prevent sac re-enlargement after late open conversion.
Background
Late open conversion has sometimes been required for sac enlargement after endovascular
aneurysm repair (EVAR) for abdominal aortic aneurysm. Though the open repair with
endograft preservation is considered less invasive compared to endograft removal,
the mid-term outcomes are still unclear. The aim of this study is to evaluate the
mid-term outcomes of late open conversion with endograft preservation after EVAR.
Methods
We reviewed patients who underwent late open conversion with endograft preservation
for sac enlargement or rupture in our institution from May 2007 to December 2020.
The open repair mainly consisted of ligation of lumber arteries or the median sacral
artery and sacotomy. We additionally performed wrapping of plicated aneurysm with
equine pericardium as much as possible. Patients were followed-up by a computed tomography
scan and duplex ultrasound 1 and 6 months postoperatively, and each year thereafter.
Results
Of the 1,087 patients who underwent EVAR, 23 patients with a mean age of 81.5 years
were included in this study. The mean duration post-EVAR was 35.6 months. Sac wrapping
with equine pericardium was performed in 14 patients (60.9%). We additionally performed
wrapping of the endograft junction by a Dacron knitted fabric in 1 case with type
III endoleak and aortic neck banding in 4 cases with type I endoleak. The 30-day mortality
was 0% and the rate of major complications was 4%. All-cause mortality was 21.7% which
included 1 aneurysm-related death during a mean follow-up of 38.5 months. Sac re-enlargement
was observed in 4 patients without the wrapping method. At 3 years, the aneurysmal
diameter in the nonwrapping group significantly increased, compared with the wrapping
group (P = 0.011).
Conclusions
Late open conversion with endograft preservation is a feasible treatment; however,
at times re-enlargement of the sac aneurysm occurs. The wrapping method has the potential
to prevent sac re-enlargement after open conversion.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Annals of Vascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trans-femoral intraluminal graft implantation for abdominal aortic aneurysms.Ann Vasc Surg. 1991; 5: 491-499
- Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial.Lancet. 2004; 364: 843-848
- A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms.N Engl J Med. 2004; 351: 1607-1618
- Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial.Lancet. 2016; 388: 2366-2374
- Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: the EUROSTAR experience.J Vasc Surg. 2002; 35: 461-473
- Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes.J Vasc Surg. 2007; 46: 1-8
- Type II endoleaks after endovascular repair of abdominal aortic aneurysm are not always a benign condition.J Vasc Surg. 2013; 57: 1291-1297
- Outcomes of percutaneous endovascular intervention for type II endoleak with aneurysm expansion.J Vasc Surg. 2012; 55: 1263-1267
- Long-term follow-up of type II endoleak embolization reveals the need for close surveillance.J Vasc Surg. 2012; 55: 33-40
- Outcomes after late explantation of aortic endografts depend on indication for explantation.Ann Vasc Surg. 2013; 27: 865-873
- Late open conversions after endovascular abdominal aneurysm repair in an urgent setting.J Vasc Surg. 2019; 69: 423-431
- Technical considerations for late removal of aortic endografts.J Vasc Surg. 2002; 36: 674-678
- Obliterative endoaneurysmorrhaphy with stent graft preservation for treatment of type II progressive endoleak.Eur J Vasc Endovasc Surg. 2016; 51: 38-42
- Elective late open conversion after endovascular aneurysm repair is associated with comparable outcomes to primary open repair of abdominal aortic aneurysms.J Vasc Surg. 2021; 73: 502-509.e1
- Increasing use of open conversion for late complications after endovascular aortic aneurysm repair.J Vasc Surg. 2019; 69: 1766-1775
- Surgical conversion with graft salvage as a definitive treatment for persistent type II endoleak causing sac enlargement.J Vasc Surg. 2015; 62: 1437-1441
- Treatment of sac expansion after endovascular aneurysm repair with obliterating endoaneurysmorrhaphy and stent graft preservation.J Vasc Surg. 2016; 63: 902-908
- Delayed open conversions after endovascular abdominal aortic aneurysm repair.J Vasc Surg. 2012; 55: 1562-1569.e1
- Ten-year results of endovascular abdominal aortic aneurysm repair from a large multicenter registry.J Vasc Surg. 2013; 58: 324-332
- Long-term outcomes of secondary procedures after endovascular aneurysm repair.J Vasc Surg. 2010; 52: 1442-1449
- Late open conversion after endovascular abdominal aortic aneurysm repair.J Vasc Surg. 2015; 61: 1350-1356
- Type II endoleak: transperitoneal sacotomy and ligation of side branch endoleaks responsible for aneurysm sac expansion.J Endovasc Ther. 2002; 9: 539-542
- Outcomes of late open conversion after endovascular abdominal aneurysm repair.Ann Vasc Dis. 2019; 12: 340-346
Article Info
Publication History
Published online: July 31, 2022
Accepted:
June 29,
2022
Received:
April 20,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
