Late surgical conversion after failed endovascular aortic repair: Our single-institutional experience

Objectives: In this study, we report our single-center experience with late surgical conversion (SC) after endovascular aneurysm repair (EVAR) and risk factors for reintervention. Patients and methods: Between January 2007 and December 2017, a total of 98 patients (94 males, 4 females; mean age: 69.1±8.6 years; range, 35 to 86 years) who underwent infrarenal EVAR were retrospectively analyzed. During the study period, additional eight patients who underwent EVAR at an external center were referred to our center. Overall, nine patients underwent late SC. In the late SC group, stent grafts used for EVAR were Endurant™ (n=5), Talent™ (n=2), Powerlink™, and Anaconda™ (n=1). Results: The mean time from initial EVAR to open conversion was 45.3±35.4 months. Four (44.4%) patients presented with more than one different concomitant indications. The most frequent reason for the late SC was type 3 endoleak (n=5, 55.5%). Late SC was performed electively in five (55.5%) patients. Partial stent graft removal was performed in three (33.3%), complete removal in three (33.3%), and complete preservation of the stent graft in three (33.3%) patients. Among 98 patients, the mean aneurysm diameter was significantly higher in those with late complication and undergoing second EVAR (p=0.001). The cut-off value for second EVAR was ≥66 mm with a sensitivity of 88.89% and specificity of 71.91% (p=0.001). Conclusion: The surveillance program after EVAR is of utmost importance to ensure that patients do not need urgent conversion, particularly in patients with an initial aneurysm diameter of ≥66 mm.