Late Open Conversion After Failed EVAR: Treatment and Results – A Series of Thirty Cases

Introduction: Late open conversions are most commonly due to migration, endoleaks, aneurysmal degeneration of the seal zones , device material failure and can occur at different times after AAA endovascular repair. The aim of the study is to present our results and “tips and tricks” for the late open conversion after failed EVAR. Methods: From 2009 to 2019 we performed 784 EVARs in our clinic. During this period 30 patients required open conversion for failed EVAR caused by different reasons: seven for Type I endoleak, five for Type II endoleak, two for Type III endoleak, three for endotension, five for stent-graft migration, two for secondary aneurysm rupture, five for stent-graft thrombosis and one for stent-graft infection.Different devices were used for EVAR: Zenith, Endurant, Aorfix, LeMaitre, Nellix, Treo. Nine EVARs have been performed in other hospitals. Fourteen redo operations (46,6%) have been performed as emergent intervention. Results: All procedures have been performed under general anesthesia and required laparotomy with partial or total stent-graft explantation. In two cases we left the stent-graft in place, we sutured lumbar arteries with partial resection of aneurysm sac. For bleeding control from aorta we used Coda balloon indroduced from axillary access in all cases. After explantation of the stent-graft we implanted tube or bifurcated dacron graft and in patient with infected stent-graft it was replaced with a custom-made biological graft sewn from porcine pericardium patches. In some cases ttere was a need to adapt the graft to different diameters of remaining stent-graft part and native arteries. In cases with elevated risk of infection we cover the aneurysm sac with omental flap. Thirty-day mortality was 13,3 %. Twenty six patients stay in follow-up. All grafts are patent. Conclusion: In these patients, when there are no further options for endovascular treatment open repair represents a valuable solution for them. Preoperative planning, accurate time for conversion, the operator surgical technique are the key factors of success in these technically demanding procedure. Disclosure: Nothing to disclose