Long-term results of late open conversions with partial or total removal of noninfected stent grafts after failed endovascular aneurysm repair

Abstract

Objective

Open surgical conversion after failed EVAR has become more common. Our aim was to compare the short- and long-term results of late open conversions for noninfectious indications with partial or total stent graft removal.

Methods

Our study is a retrospective, multicenter observational study of late open conversions performed in five hospitals between January 1997 and June 2024. Patients who underwent a partial or total removal of a stent graft more than 30 days after EVAR for noninfectious indications were included in the analysis and divided into two groups: partial conversion (PC) and total conversion (TC). The primary outcomes were 30-day mortality, 5-year survival, and freedom from late complications. The secondary outcomes were perioperative cardiovascular complications, length of hospital stay, and 5-year freedom from reinterventions and from aneurysm-related death.

Results

The analysis included 97 patients: 57 (58.8%) in the PC group and 40 (41.2%) in the TC group. The 30-day mortality in the PC group was lower compared with the TC group (14.3% vs 24.3%; odds ratio, 0.52; P = .220), although the difference did not reach statistical significance. The estimated 5-year overall survival was similar in the PC and TC groups (58.8% vs 59.8%; P = .726). The patients in the PC group had no infections or thrombosis and a similar freedom from late complications compared with the TC group (81.2% vs 84.0%; P = .788). A subgroup analysis comparing the preoperative CTA scans and intraoperative observations revealed an occult endoleak in 22 patients (22.7%), and in the 12 patients (12.4%) who underwent surgery for a suspected endoleak, none were identified during the procedure.

Conclusions

PC seems to be noninferior to TC and possibly even safer, with a trend toward lower mortality in the short term. No differences in mortality or complications were found between the groups during long-term follow-up.