Open decompression, proximal banding, and aneurysm sac fenestration as an alternative to conversion in the management of endotension after EVAR.

Purpose: To present a technique to treat endotension and avoid surgical conversion after endovascular aneurysm repair (EVAR).

Technique: The surgical procedure is based on decompression, downsizing, and fenestration of the aneurysm sac combined with proximal aortic neck banding and transmural endograft fixation with sutures. Among 193 patients who underwent infrarenal EVAR between October 2001 and October 2007, 3 (1.5%) patients developed endotension without evidence of endoleak (increasing aneurysm diameter in 2 and a pulsating aneurysm with unchanged diameter in the third). This technique was applied successfully in uneventful procedures. Considerable shrinkage of the aneurysm sac has been observed over a 13- to 31-month follow-up.

Conclusion: This open surgical procedure is a safe and effective treatment for endotension and can avoid conversion. More experience is needed for definitive evaluation.