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 SS8. The First 100 Late EVAR Explants: Largest Single Center Experience

Eric J. Turney, Sean Steenberge, Sean Lyden, Matthew Eagleton, Sunita Srivastava, Timur Sarac, Rebecca Kelso, Daniel Clair
Vascular Surgery, Cleveland Clinic, Cleveland, OH.

OBJECTIVES: With more than a decade of use of endovascular aneurysm repair (EVAR), we have seen a rise in the number of failing endografts. In 2007, we previously reported 41 explants and sought to re-examine our outcomes.
 
METHODS: A retrospective analysis of EVARs requiring late explant was performed using a database. The type of graft, duration of implant, reason for removal, operative technique, mortality and length of stay were reviewed.
 
RESULTS: During 1999-2012, 100 patients required explant, of which 60 were placed at an outside institution (Table 1). Twenty-seven were performed in the last 2 years. Ninety-one males with an average age of 75 (range 50-93 years). Grafts were excised after a median of 41 months (range 1-144 months). Average length of stay was 15 days (range 1-56 days). Thirty-day mortality was 17%. Elective mortality was 9.9%. There was no difference in approach (56 retroperitoneal, 44 midline). Eighty-two percent of patients had one or more endoleaks (type I-40, II-30, III-22, endotension-6). Migration (15), rupture (9), aortoenteric fistula (5), infection (13), limb thrombosis (3) and claudication (1) were also factors. Repairs were tube 18, aortoiliac 66, aorto-femoral 8, axillofemoral 7. Twenty-two patients had partial-graft excision.
 
CONCLUSIONS: An increasing number of endografts are being referred for removal. The overall mortality is slightly improved to 17% from 19% in our original series despite increased elective mortality to 9.9% from 3.3%.
 
AUTHOR DISCLOSURES: D. Clair: Boston Scientific, Consulting fees or other remuneration (payment); Cordis, Consulting fees or other remuneration (payment); Covidien, Consulting fees or other remuneration (payment) Endologix, Consulting fees or other remuneration (payment); eV3, Consulting fees or other remuneration (payment); Medtronic, Consulting fees or other remuneration (payment); Vessix Vascular, Consulting fees or other remuneration (payment); WL Gore, Consulting fees or other remuneration (payment); M. Eagleton: Cook Medical, Consulting fees or other remuneration (payment); Bolton, Consulting fees or other remuneration (payment); R. Kelso: Nothing to disclose; S. Lyden: Medtronic, Consulting fees or other remuneration (payment); Cook Medical, Consulting fees or other remuneration (payment); WL Gore, Consulting fees or other remuneration (payment); T. Sarac: Peritec Biosciences, Ownership or partnership; S. Srivastava: Nothing to disclose; S. Steenberge: Nothing to disclose; E. J. Turney: Nothing to disclose.
 
Graft Type​

​N

AneuRx​ ​25
Excluder​ ​25
Zenith​ ​17
Talent​ ​15
​Ancure ​10
​Powerlink ​4
Endurant ​ ​1
Quantum LP​ ​1
Uni Iliac Rupture Graft ​ ​1
​Home Made ​1
 
Posted April 2013

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