Anatomy of a Rescue: Explantation and Reconstruction After Complex Endovascular Aortic Repair—A Systematic Review of Case Reports

Background: Explantation after chimney, fenestrated, or branched endovascular aortic repair is technically demanding because major arterial branches are incorporated into the device. Objective: To identify recurring principles of operative decision-making for partial or complete explantation, with an emphasis on infection extent, incorporated branch management, reconstruction, and staging. Methods: PubMed/MEDLINE and Scopus were searched from inception through 21 August 2026 for patient-level reports of surgical explantation after complex endovascular aortic repair. Two reviewers independently selected studies, extracted data, and assessed methodological quality with the Joanna Briggs Institute checklist and reporting completeness with CARE. Findings were synthesized descriptively; the protocol was registered in PROSPERO (CRD420261412667). Results: Ten single-patient reports published from 2015 to 2025 were included. Patients were aged 51–78 years (median, 73), and nine were men. Infection prompted eight explantations; renal chimney-stent thrombosis with type Ia endoleak and persistent type II endoleak with sac enlargement accounted for two mechanical failures. Computed tomography or computed tomography angiography was reported in all cases and FDG-PET/CT in five. Eight patients underwent complete and two partial explantations. Nine survived the index hospitalization. No recurrent infection was reported during the available, heterogeneous follow-up of 3–48 months. Conclusions: These selected reports identify anatomy- and source-control considerations that may guide operative planning, but they do not establish comparative effectiveness, procedural safety, or population-level outcomes.