Late conversion of aortic stent grafts.

J Vasc Surg

Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

Published: March 2009

Objectives: The frequency of late removal of endovascular abdominal aortic repair (EVAR) parallels the rise of endovascular aortic repair. Evaluation of outcomes for EVAR explants may identify risks for complications and alter clinical management.

Methods: A patient database was used to identify EVAR patients requiring explant >1 month after implant. A retrospective analysis was conducted of the type of graft, duration of implant, reason for removal, operative technique, death, and length of stay.

Results: During 1999 through 2007, 1606 EVARs were performed, and 25 patients required explantation, with an additional 16 referred from other institutions (N = 41). The average age was 73 years (range, 50-87 years); 90% were men. Grafts were excised after a median of 33.3 months (range, 3-93 months). Explanted grafts included 16 AneuRx (40%), 7 Ancure (17%), 6 Excluder (15%), 4 Zenith (10%), 4 Talent (10%), 1 Cook Aortomonoiliac rupture graft, 1 Endologix, 1 Quantum LP, and 1 homemade tube graft. Overall hospital mortality was 19% and occurred after conversion for rupture in 4, and in infected graft, aortoenteric fistula, repair of new aneurysm of the visceral segment, and claudication due to graft stenosis in one patient each. Elective EVAR-related mortality was 3.3%. Mortality was higher in patients with rupture compared with nonrupture (4 of 6 vs 3 of 35, P
Conclusion: Elective EVAR conversion, although technically challenging may be done with mortality similar to primary open repair. Mortality for conversion for infected grafts and ruptured aneurysms remains high. EVAR is associated with continued risk of conversion, and surveillance may identify late complications that require removal, justifying lifelong monitoring. Aggressive management of late complications and elective conversion may minimize the mortality associated with this procedure.

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http://dx.doi.org/10.1016/j.jvs.2008.10.020DOI Listing

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