Davidovic, Lazar B. and Palombo, Domenico and Treska, Vladislav and Sladojevic, Milos and Koncar, Igor B. and Houdek, Karel and Spinella, Giovanni and Zlatanovic, Petar and Pane, Bianca (2020) Late open conversion after endovascular abdominal aortic aneurysm repair: experience of three-high volume centers. JOURNAL OF CARDIOVASCULAR SURGERY, 61 (2). pp. 183-190. ISSN 0021-9509, 1827-191X
Full text not available from this repository. (Request a copy)Abstract
BACKGROUND: Accumulated endovascular aneurysm repair (EVAR) procedures will increase number of patients requiring conversion to open repair of abdominal aortic aneurysms (AAA). In most cases, patients undergo late open surgical conversion (LOSC), many months, or years, after initial EVAR. The aim of this study is to analyze results of LOSC after EVAR in elective and urgent setting, including presenting features, surgical techniques, as well as to review the clinical outcomes and their predictors. METHODS: Retrospective review of all consecutive patients undergoing LOSC after EVAR was performed at three distinct, high volume, vascular centers. Patients that required primary conversion within 30 days after EVAR have not been included in this study. Between January 1st 2010 and January 1st 2017 total of 31 consecutive patients were treated. LOSC were performed either in elective or in urgent setting, thus dividing patients in two groups. Primary outcome was 30-day mortality and secondary postoperative complications RESULTS: LOSC rate after EVAR was 4.51%. Most common indication for LOSC was type I endoleak (N.=20, 64.51%). All patients that presented with ruptured AAA had some form of endoleak (type I endoleak was present in five from six cases). Most common site for aortic crossclamping was infrarenal (51.61%). Stent-graft was removed completely in 18 patients (58.06%) and partially in 13 (41.93%). 30-day mortality rate was 16.12% (5 patients) and most common cause of death was myocardial infarction (60%). Following univariate factors were isolated as predictors for 30-day mortality: preoperative coronary artery disease, chronic obstructive pulmonary disease, urgent LOSC, prolonged time until LOSC. ruptured AAA. supraceliac clamp. higher number of red blood cell transfusion, postoperative myocardial infarction, and prolonged intubation (more than 48 hours). CONCLUSIONS: LOSC seems to be safe and effective procedure when preformed in elective manner. On the other side, urgent LOSC after EVAR is associated with very high postoperative mortality and morbidity. Endoleak remains the main indication for open conversion. Further studies are necessary to standardize timing and treatment options for failing EVAR.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | DELAYED OPEN CONVERSION; SURGICAL CONVERSION; SECONDARY CONVERSION; GORE EXCLUDER; ENDOGRAFT; EXPLANTATION; EVAR; INTERVENTIONS; OUTCOMES; REGISTRY; Aortic aneurysm; abdominal; Endovascular procedures; Conversion to open surgery |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Chirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 29 Mar 2021 04:17 |
| Last Modified: | 29 Mar 2021 04:17 |
| URI: | https://pred.uni-regensburg.de/id/eprint/44785 |
Actions (login required)
 |
View Item |
