Partial Endograft Removal Preserves the Aortic Walls During Delayed Open Conversions of Endovascular Aortic Repair.

Background: Open conversion of endovascular aortic repair (EVAR) is the first-choice treatment in case of endograft failure or high-flow endoleak. However, the traditional technique based on the total removal of the endograft can produce injuries of the aortic walls, with severe consequences on the anastomoses quality. Our aim is to show the advantages of the partial endograft removal on the aortic integrity by reporting a case series including 25 delayed open conversion performed with this technique.

Methods: A retrospective study was conducted over the cases of delayed open conversions performed in the last 30 months. Demographics, past medical history, endograft type, causes for conversions, and early and mid-term outcomes were recorded and analyzed in relation with the technique employed (partial vs total endograft removal).

Results: Between September 2016 and March 2019, 25 consecutive cases of EVAR failure were converted to open treatment. In all cases, the endografts were resected leaving in place part of the iliac branches, and, whenever possible, also the proximal stent of the main body. Primary technical success was achieved in 100% of cases. Disease-free survival over 18-month median follow-up was 100%. All patients underwent abdominal aortic duplex scan controls as scheduled, with no early or late postoperative complication. No anastomotic aneurysms or any surgery-related complications were observed.

Conclusions: Partial endograft removal is a safe and effective technique that could be used to protect the aortic integrity in delayed open conversions of EVAR.