title: Conversion to open repair after endografting for abdominal aortic aneurysm: a review of causes, incidence, results, and surgical techniques of reconstruction.
abstract: OBJECTIVE
  To review the incidence, causes, and mortality rates of early and late conversion to open surgery after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA).
  
  
  METHODS
  A systematic search of the English-language literature from 2002 to 2009 was performed by interrogation of the PubMed, MEDLINE, and EMBASE databases. Studies were included if they: (1) had >100 patients treated with EVAR and (2) provided adequate data to calculate incidence and associated mortality rates. The search yielded 13 articles with sufficient data to analyze early conversion (12,236 patients, 178 conversions) and 15 articles with available data for late conversion (14,298 patients, 279 conversions).
  
  
  RESULTS
  The rate of early conversion among the 13 articles reviewed ranged from 0.8% to 5.9%; more recent studies carried lower rates of early conversion. Mortality rates of early conversion varied between 0% and 28.5%. Overall, there were 178 (1.5%) early conversions among the 12,236 AAAs treated with EVAR, with an average mortality of 12.4%. The rates of late conversion ranged from 0.4% to 22%. Of the 14,289 AAA patients undergoing endovascular repair, 279 (1.9%) required late conversion; the mortality rate was 10%.
  
  
  CONCLUSIONS
  Though the incidence is gradually declining, secondary interventions persist as the Achilles' heel of EVAR. A lifelong follow-up strategy for AAA patients treated with EVAR is essential for early detection and treatment of complications of the procedure. Vascular surgeons should be familiar with the complex open conversion procedures.
authors.affiliation: Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece. konmoulakakis@yahoo.gr
authors.forename: Konstantinos G
authors.initials: KG
authors.lastname: Moulakakis
authors.forename: Ilias
authors.initials: I
authors.lastname: Dalainas
authors.forename: Spyridon
authors.initials: S
authors.lastname: Mylonas
authors.forename: Triantafillos G
authors.initials: TG
authors.lastname: Giannakopoulos
authors.forename: Efthimios D
authors.initials: ED
authors.lastname: Avgerinos
authors.forename: Christos D
authors.initials: CD
authors.lastname: Liapis
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D020878:Device Removal; D057867:Endoleak / Q000209:etiology / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005548:Foreign-Body Migration / Q000209:etiology / Q000601:surgery; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome