title: Late open conversion after endovascular aneurysm repair.
abstract: OBJECTIVE
  Endovascular treatment of the infrarenal abdominal aorta (endovascular repair, EVAR) has emerged as an alternative to open surgery. However, a small subset of patients exists who undergo conversion either in the first 30 postoperative days or later during the course of postoperative surveillance. In the present study, we review our experience with late conversion operations.
  
  
  METHODS
  Between December 2004 and August 2012, 411 EVARs were performed. During the same time interval, nine patients (males) with a mean age of 71 years (range, 59-79 years) required late open conversion. The median interval between EVAR and the conversion operation was 34 months (range 14-60 months).
  
  
  RESULTS
  The indications for late conversion included persistent proximal type I endoleak (n = 2), type II endoleak with sac enlargement (n = 1), aneurysm rupture (n = 1), endotension (n = 2), stent-graft thrombosis (n = 1) and stent-graft infection (n = 2). Complete stent-graft explantation was performed in five patients. Eight patients underwent elective conversion. One patient presenting with rupture had an emergency operation. The 30-day mortality rate was 0%.
  
  
  CONCLUSIONS
  Late open conversion after EVAR can be performed safely and successfully. Complete stent-graft explantation may be our preferred treatment option, but it is not always necessary, except in cases presenting with graft infection.
authors: Center of Vascular Medicine, Angiology and Vascular Surgery, Park Hospital Leipzig, Leipzig, Germany Faculty of Health, Witten/Herdecke University, Witten, Germany botsios@arcor.de.
authors: Spiridon
authors: S
authors: Botsios
authors: Center of Vascular Medicine, Angiology and Vascular Surgery, Park Hospital Leipzig, Leipzig, Germany.
authors: Yvonne
authors: Y
authors: Bausback
authors: Center of Vascular Medicine, Angiology and Vascular Surgery, Park Hospital Leipzig, Leipzig, Germany.
authors: Michael
authors: M
authors: Piorkowski
authors: Center of Vascular Medicine, Angiology and Vascular Surgery, Park Hospital Leipzig, Leipzig, Germany.
authors: Martin
authors: M
authors: Werner
authors: Center of Vascular Medicine, Angiology and Vascular Surgery, Park Hospital Leipzig, Leipzig, Germany.
authors: Daniela
authors: D
authors: Branzan
authors: Center of Vascular Medicine, Angiology and Vascular Surgery, Park Hospital Leipzig, Leipzig, Germany.
authors: Dierk
authors: D
authors: Scheinert
authors: Center of Vascular Medicine, Angiology and Vascular Surgery, Park Hospital Leipzig, Leipzig, Germany.
authors: Andrej
authors: A
authors: Schmidt
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D020878:Device Removal / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Abdominal aorta; Aneurysm; Complications; Endovascular treatment; Open conversion