Surgical conversion after endovascular grafting for abdominal aortic aneurysms.
OBJECTIVE
To analyze the indications, results, and technical problems associated with conversion after endoluminal repair of abdominal aortic aneurysms (AAA) based on a 6-year experience in endovascular grafting.


METHODS
From August 1994 to May 2000, 520 patients with AAA were deemed candidates for endovascular therapy based on data from contrast-enhanced computed tomography and aortography. Any conversions were performed using an open operation modified according to the indication for conversion, elapsed time from the endoluminal repair, and type of endograft (tube, bifurcated, infra-/suprarenal fixation).


RESULTS
Conversion to open repair was required in 37 (7.1%) cases: 23 tube grafts and 14 bifurcated devices. Seventeen (3.2%) conversions occurred at the original operation and 20 (3.8%) were performed secondarily. Indications for primary conversion were mainly device defects (n = 5) or access problems (n = 5), while secondary conversion was primarily owing to type I endoleak (n = 16). The conversion rate was significantly higher in modular devices (5.9%) than unibody designs (1.4%) (p = 0.003). The rate of primary conversions diminished from 10.9% in 1994-1995 to 2.4% between 1996 and 2000, as did the overall mortality rate, from 8.3% in the first time period to 0% in the second for elective conversions, but emergency operations had 40% mortality.


CONCLUSIONS
Most AAAs require bifurcated devices for complete exclusion, and older model modular grafts have higher conversion rates. Primary conversion decreases as more experience in endoluminal grafting is acquired. Emergency open repair results in a high mortality rate.
Böckler
Dittmar
D
Klinik für Gefässchirurgie, Vaskuläre und Endovaskuläre Chirurgie, Klinikum Nürnberg Sud, Germany. dittmar.boeckler@rzmail.uni-erlangen.de
Probst
Thomas
T
Weber
Heinz
H
Raithel
Dieter
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D001027:Aortography; D021721:Balloon Occlusion / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data