title: Seventeen years' experience of late open surgical conversion after failed endovascular abdominal aortic aneurysm repair with 13 variant devices.
abstract: OBJECTIVE
  To investigate the causes and results of late open surgical conversion (LOSC) after failed abdominal aortic aneurysm repair (EVAR) and to summarize our 17 years' experience with 13 various endografts.
  
  
  METHODS
  Retrospective data from August 1994 to January 2011 were analyzed at our center. The various devices' implant time, the types of devices, the rates and causes of LOSC, and the procedures and results of LOSC were analyzed and evaluated.
  
  
  RESULTS
  A total of 1729 endovascular aneurysm repairs were performed in our single center (Nuremberg South Hospital) with 13 various devices within 17 years. The median follow-up period was 51 months (range 9-119 months). Among them, 77 patients with infrarenal abdominal aortic aneurysms received LOSC. The LOSC rate was 4.5 % (77 of 1729). The LOSC rates were significantly different before and after January 2002 (p < 0.001). The reasons of LOSC were mainly large type I endoleaks (n = 51) that were hard to repair by endovascular techniques. For the LOSC procedure, 71 cases were elective and 6 were emergent. The perioperative mortality was 5.2 % (4 of 77): 1 was elective (due to septic shock) and 3 were urgent (due to hemorrhagic shock).
  
  
  CONCLUSIONS
  Large type I endoleaks were the main reasons for LOSC. The improvement of devices and operators' experience may decrease the LOSC rate. Urgent LOSC resulted in a high mortality rate, while selective LOSC was relatively safe with significantly lower mortality rate. Early intervention, full preparation, and timely LOSC are important for patients who require LOSC.
authors.affiliation: Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Rd., Shangcheng District, Hangzhou, Zhejiang Province, People's Republic of China, wuziheng303@hotmail.com.
authors.forename: Ziheng
authors.initials: Z
authors.lastname: Wu
authors.forename: Liang
authors.initials: L
authors.lastname: Xu
authors.forename: Lefeng
authors.initials: L
authors.lastname: Qu
authors.forename: Dieter
authors.initials: D
authors.lastname: Raithel
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome