title: Outcomes after late explantation of aortic endografts depend on indication for explantation.
abstract: BACKGROUND
  With the growing prevalence of endovascular repair for abdominal aortic aneurysm (AAA), the number of patients requiring graft explantation is increasing. Therefore, knowledge related to outcomes after explantation may lead to improvement in surgical options. In this study we compare our experience with explantation of aortic endografts, based on indication.
  
  
  METHODS
  The medical records of all aortic procedures performed at our center were queried during the period from 2002 to 2012. Relevant data from patients needing explantation of aortic endografts were analyzed using Fisher's exact test, t-test, and Kaplan-Meier analysis.
  
  
  RESULTS
  Thirty-nine patients underwent aortic endograft explantation (64.1% men). Mean age was 71.9 years with a mean aneurysm size of 6.8 cm (range 3.5-10.7 cm). Hypertension (97.4%), hyperlipidemia (76.9%), and history of smoking (82%) were the most prevalent risk factors. Mean time to explant was 41.7 months (range 2.2-118.4 months). The primary explant indication was endoleak in 27 (69.2%) and infection in 12 (30.8%) patients. The endoleak group consisted of 13 type I, 8 type II, 1 type III, 4 endotension, 1 rupture, and 4 patients with multiple endoleaks. Seven patients were symptomatic, whereas 2 had ruptured aneurysms. Half of the patients in the infection group required supraceliac clamping for explantation. Operative blood loss (P = 0.08) and need for transfusion (P = 0.005) were significantly higher in the infection group. Thirty-day morbidity was 51.8% for the endoleak group and 83% for the infection group (P = 0.08). There were only 2 deaths in the cohort within 30 days, both in the infection group. Twenty-seven patients were alive at a mean follow-up of 1.9 years (range 0.1-8.4 years).
  
  
  CONCLUSIONS
  Endograft explantation is a challenging operation with high morbidity and mortality. Furthermore, patients with an infectious etiology have significantly worse outcomes than those requiring explantation for endoleaks.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Emory University, Atlanta, GA.
authors.forename: Shipra
authors.initials: S
authors.lastname: Arya
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Coleman
authors.forename: Jordan
authors.initials: J
authors.lastname: Knepper
authors.forename: Peter K
authors.initials: PK
authors.lastname: Henke
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
authors.forename: John E
authors.initials: JE
authors.lastname: Rectenwald
authors.forename: Enrique
authors.initials: E
authors.lastname: Criado
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Eliason
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Gallagher
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D020878:Device Removal / Q000009:adverse effects / Q000401:mortality; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome