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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 12/2020

01-12-2020 | REVIEW

Late Open Conversion Following Failure of EVAR and TEVAR: “State of the Art”

Authors: Enrico Rinaldi, Andrea Kahlberg, Niccolò Carta, Daniele Mascia, Luca Bertoglio, Roberto Chiesa

Published in: CardioVascular and Interventional Radiology | Issue 12/2020

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Abstract

Abdominal endovascular aneurysm repair (EVAR) and thoracic endovascular aneurysm repair (TEVAR) have changed the aortic surgery, due to several advantages in terms of reduced morbidity and mortality. However, increasing rate of late complications requiring secondary procedures has been observed over time. Even if the majority of them may be treated by means of endovascular techniques, late open surgical conversion (LOSC) is required in specific situations. This paper aims to provide our single-center experience with LOSCs and an updated review of the literature. From 1995 to 2020, indications and outcomes of patients treated with LOSC for failed EVAR and TEVAR, at our institutions, were analyzed. LOSC was required to treat a broad range of complications that were classified into two main groups: “disease related” and “stent-graft (SG) related.” Among the 121 patients treated with LOSC after EVAR, endoleak (75.2%) represented the most common indication. The overall 30-day mortality rate was 3.3%. A higher mortality rate was associated with infection after EVAR (p. 006). Among the 81 patients treated with LOSC after TEVAR, endoleak (32.1%) was the most common indication. The overall 30-day mortality rate was 13.6% with a higher incidence in the SG-related group (p. 02). LOSC is associated with an increased surgical complexity, in both the abdominal and thoracic area, that results in higher morbidity and mortality rates compared with standard open repair. Depending on the indication to LOSC, specific surgical maneuvers are required to improve clinical outcomes.
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Metadata
Title
Late Open Conversion Following Failure of EVAR and TEVAR: “State of the Art”
Authors
Enrico Rinaldi
Andrea Kahlberg
Niccolò Carta
Daniele Mascia
Luca Bertoglio
Roberto Chiesa
Publication date
01-12-2020
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 12/2020
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-020-02636-w

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