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Home > Vascular Annual Meeting > kelso_late_conversion

Late Conversion of 41 Aortic Stent Grafts

Rebecca L. Kelso, Sean P. Lyden, Brett Butler, Roy K. Greenberg, Matthew J. Eagleton, Daniel G. Clair.
Cleveland Clinic, Cleveland, Ohio.

OBJECTIVES: Many complications can follow infrarenal endovascular aneurysm repair (EVAR), resulting in a risk of conversion and rupture. Evaluation of EVARs explanted may identify factors that alter clinical management.

METHODS: All patient who underwent late (>30 days) EVAR explanation were retrospectively analyzed. The prosthesis type, indication for removal, operative technique, mortality and other clinical variables were reviewed.

RESULTS: Between 1999-2007, 1606 EVARs were performed and 41 patients required explanation (16 implanted at outside institutions). 90% were male with an average age of 73 (range 50-87 years). Grafts were excised after 33 months (median, range 3-91 months). Explanted grafts included 16 (40%) AneuRx, 7 (17%) Ancure, 6 (15%) Excluder, 4 (10%) Zenith, 4 (10%) Talent, 1 Cook Aorto-monoiliac rupture graft, 1 Powerlink, 1 Quantum LP and 1 Homemade graft. Average length of stay was 16 days and no outcomes differences were related to surgical approach (46% retroperitoneal vs. 54% midline). 30 day mortality was 15% which occurred in patients conversion for rupture (4), infected graft (1), aortoenteric fistula (1), aneurysm of the visceral segment not contiguous with the AAA (1) and claudication due to graft stenosis (1). The patient with claudication was the only mortality in non-urgent conversion for an AAA related problem (Non urgent EVAR related mortality 2.4%). Rupture was due to Type I, Type III endoleak or graft migration and had a higher mortality than non-ruptured (4/6 vs. 3/35, p≤0.01).

Proximal aortic control was primarily above the endograft (supravisceral 23, suprarenal 12, infrarenal 6). Repair was most commonly bifurcated rather than aorto-aortic (63% vs. 25%). Grafts with suprarenal fixation had a longer clamp time (43min vs. 28min-infrarenal fixation). Goal was complete graft removal, however, in selected cases residual graft components were incorporated into the repair.

CONCLUSIONS: Elective conversion of EVAR is safe and similar to primary open repair. Urgent repair for rupture or infection has a mortality. Conversion should occur early for patients who fail endovascular salvage attempts for type I, III endoleaks and migration.

AUTHOR DISCLOSURES: R.L. Kelso, None; S.P. Lyden, Cook; B. Butler, None; R.K. Greenberg, Cook; Gore; Cook; M.J. Eagleton, None; D.G. Clair, Medtronic.