title: Open conversion after endovascular aortic aneurysm repair: a single-center experience.
abstract: BACKGROUND
  The endovascular treatment of an abdominal aortic aneurysm (AAA) is a treatment with low risk and good reported results. This retrospective study analyzed experience with patients requiring surgical conversion after endovascular abdominal aortic aneurysm repair (EVAR).
  
  
  METHODS
  A total of 26 patients underwent open conversion (OC) after EVAR (18 endografts implanted at the authors' center and 8 in other centers). Patients were divided into 2 groups: early conversion if OC was performed within 30 days from the primary EVAR, and late conversion if OC was performed at least 30 days after EVAR. The authors analyzed all data on OC and the postoperative course.
  
  
  RESULTS
  In this series, OC was performed for 22 endoleaks (13 type I, 5 type II, 2 type III, and 2 type V, which in 5 cases these were associated with AAA ruptures), 2 renal artery coverages, and 2 endograft infections. Six (23%) patients underwent early conversion with a mortality rate of 50%, and 20 (77%) had late conversion with a mortality rate of 20%. The overall mortality rate after OC, occurring before hospital discharge or within 30 days, was 26.9% (7 of 26).
  
  
  CONCLUSIONS
  Endoleaks remain the weak point of endografts and can result in aneurysm rupture/death. Urgent OC and infections engender a high mortality. Elective OC can be performed with very low mortality and acceptable morbidity. Lifelong surveillance is necessary to detect and treat endoleaks.
authors.affiliation: Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy. emaferrero@libero.it
authors.forename: Emanuele
authors.initials: E
authors.lastname: Ferrero
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Ferri
authors.forename: Andrea
authors.initials: A
authors.lastname: Viazzo
authors.forename: Alberto
authors.initials: A
authors.lastname: Pecchio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Berardi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Piazza
authors.forename: Matteo
authors.initials: M
authors.lastname: Ripepi
authors.forename: Emilio
authors.initials: E
authors.lastname: Benintende
authors.forename: Franco
authors.initials: F
authors.lastname: Nessi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D004630:Emergencies; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome