Late open conversion after failed endovascular aortic aneurysm repair

摘要: Objective Endovascular aortic aneurysm repair (EVAR) is widely used for the treatment of abdominal aneurysms. Complications secondary to EVAR are also treated with endovascular techniques. When this not applicable, open surgical mandatory. This study aims present our experience in after failed EVAR. Methods Within period from 2004 through 2013, 18 patients (17 men; mean age, 73.9 years) were operated on because failure due persistent type II endoleak (n = 10), I or III 3), mixed-type endoleaks 2), stent graft thrombosis and aortoenteric fistulae 1). Stent grafts Zenith 8), Talent 4), Excluder Anaconda 2). Results Mean time interval between conversion was 36 months (range, 2-120 months). Fifteen (83.3%) operations elective, three (16.7%) urgent rupture 2) fistula Six (33.3%) simple ligation culprit vessels, without clamping explantation. In six patients, partially removed except segment attached proximal neck, while five (27.8%) complete removal necessary. Finally, one patient, endoleak, a hybrid performed. Clamping aorta necessary 12 (66.7%) (infrarenal, n = 10 suprarenal, Overall operative mortality 5.6%. Postoperative complications included wall defect requiring revision paroxysmal atrial fibrillation both same case pulmonary infection, prolonged intubation intensive care unit stay 6 days. Conclusions Late remains challenging. Avoidance cross-clamping if possible, partial total preservation may improve outcomes terms morbidity. Elective seem be associated better outcomes, prompting thus close follow-up early decision other options doubtful.