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 RR25. Outcomes Following Late Explantation of Aortic Endografts Depend on the Indication

Shipra Arya1, Dawn M. Coleman1, Jordan Knepper1, Peter K. Henke1, Gilbert R. Upchurch2, John E. Rectenwald1, Enrique Criado1, Jonathan L. Eliason1, Katherine Gallagher1
1Vascular Surgery, University of Michigan, Ann Arbor, MI; 2University of Virginia, Charlottesville, VA.

OBJECTIVES: This study compares our experience with explantation of aortic endografts for endoleak vs. infection.

METHODS: The medical records of 1,500 aortic procedures performed at our center were queried from 2002-2011. Relevant data from patients needing explantation of aortic endografts was analyzed.

RESULTS: Thirty-six patients underwent aortic explantation (63.9% male). Mean age was 71.6 years with a mean aneurysm size of 6.6cm (range 3.5-10.7 cm). Hypertension (97%), hyperlipidemia (77.8%) and smoking (83%) were the most prevalent risk factors. Mean time to explant was 45.3 months (range 2.2-118.4 months). The primary explant indication was endoleak in 24 (66.7%) and infection in 12 (33.3%) patients. Thirty-day morbidity was 54% (endoleak) and 83% (infection). There were 2 deaths (16.7%) in the infection group within 30 days. Five patients were symptomatic, while 2 patients had ruptured aneurysms. In the endoleak group, there were 9 type Ia, 7 type II, 1 type III, 3 type V, 1 rupture and 3 patients with multiple endoleaks. Seventy-eight percent of patients were alive at a mean follow-up of 17. 4 months.

CONCLUSIONS: This is the largest endograft explantation series to date. Patients with an infectious etiology have significantly worse morbidity and mortality than patients requiring explantation for endoleaks.

AUTHOR DISCLOSURES: S. Arya, Nothing to disclose; D. M. Coleman, Nothing to disclose; E. Criado, Nothing to disclose; J. L. Eliason, Nothing to disclose; K. Gallagher, Nothing to disclose; P. K. Henke, Nothing to disclose; J. Knepper, Nothing to disclose; J. E. Rectenwald, Nothing to disclose; G. R. Upchurch, Nothing to disclose.

 

Peri-operative variables by indication for explant

Peri-operative variable
Endoleak (n=24)
Infection (n=12)
Males (%)
50.0
91.7*
ASA class >3 at explant (%)
50.0
66.7*
Supra-mesenteric clamping (%)
4.4
50.0*
Re-exploration needed (%)
4.2
41.7*
Post op DIC (%)
0
25.0*
30-day mortality (%)
0
16.7
Intra-op blood loss (Liters)
3.3
6.3*
Mean PRBCs transfused intra-op (n)
4.3
12.2*
ICU length of stay (days)
5.4
10.4
Length of stay (days)
12.2
18.7
ASA: American Society of Anesthesiologists; DIC: Disseminated intravascular coagulation; ICU: intensive care unit *p<0.05

 

Posted April 2012

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