Open decompression, proximal banding, and aneurysm sac fenestration as an alternative to conversion in the management of endotension after EVAR.
OBJECTIVE
To present a technique to treat endotension and avoid surgical conversion after endovascular aneurysm repair (EVAR).


METHODS
The surgical procedure is based on decompression, downsizing, and fenestration of the aneurysm sac combined with proximal aortic neck banding and transmural endograft fixation with sutures. Among 193 patients who underwent infrarenal EVAR between October 2001 and October 2007, 3 (1.5%) patients developed endotension without evidence of endoleak (increasing aneurysm diameter in 2 and a pulsating aneurysm with unchanged diameter in the third). This technique was applied successfully in uneventful procedures. Considerable shrinkage of the aneurysm sac has been observed over a 13- to 31-month follow-up.


CONCLUSIONS
This open surgical procedure is a safe and effective treatment for endotension and can avoid conversion. More experience is needed for definitive evaluation.
Mory
Martin
M
Department of Vascular and Endovascular Surgery, University of Heidelberg, Germany.
Allenberg
Jens-Rainer
JR
Schumacher
Hardy
H
von Tengg-Kobligk
Hendrik
H
Böckler
Dittmar
D
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*