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.
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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.