Open Surgical Conversion After Failed Endovascular Aneurysm Sealing

Sven R Mathisen,1 Simen Tveten Berge1,2 1Department of Vascular Surgery, Innlandet Hospital Trust, Hamar, Norway; 2Department of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, NorwayCorrespondence: Sven R Mathisen, Department of Vascular Surgery, Innlandet Hospital Trust, Hamar, Norway, Tel +47-916 38 282, Email [email protected] Simen Tveten Berge, Department of Vascular Surgery, Department of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway, Tel +47-977 23 220, Email [email protected]: The aim of this study was to investigate the early and late outcomes of Open Surgical Conversion (OSC) following the failure of Endovascular Aneurysm Sealing (EVAS) endografts, regarding surgical technique, morbidity and mortality.Method and Material: A single center retrospective observational cohort of 46 patients undergoing OSC after EVAS failure. Primary endpoints were primary technical procedural success and 30-day mortality. Secondary endpoints were complications and primary prosthesis patency.Results: Primary technical procedural success was 97.8% (45/46). Elective 30-day mortality for OSC was 10.9% (5/42) and 75% (3/4) for acute OSC procedures. Median survival after OSC was 4.2 years (IQR 1.0, 4.9 years). Four peri-operative and 17 post-operative complications were registered. Major complications included bleeding, myocardial infraction, acute renal failure and splenectomy. Primary prosthesis patency was 82.6% (38/46) at 30-days. At median follow-up of 4.7 years (IQR 3.9, 5.3 years) 69.6% (32/46) of the patients are still alive with patent vascular prostheses.Conclusion: Open surgical conversion achieved acceptable technical success rate for failed EVAS, with better outcomes in elective versus emergency procedures. Enhanced surveillance with timely interventions before rupture and careful patient selection through multidisciplinary evaluation are essential for optimizing surgical outcomes.Keywords: EVAS failure, open surgical conversion, EVAS, endoleak, secondary intervention, secondary AAA rupture