title: Surgical conversion with graft salvage as a definitive treatment for persistent type II endoleak causing sac enlargement.
abstract: OBJECTIVE
  The goal of this study was to present open surgical conversion with graft salvage or "semiconversion" as a definitive and safe treatment for untreatable and persistent type II endoleaks causing sac enlargement after endovascular aneurysm repair.
  
  
  METHODS
  Between January 2001 and December 2014, 25 of 1623 endovascular aortic repair (EVAR) patients were selected as candidates for open semiconversion. The indication was persistent type II endoleak in 13 patients (12 of whom received previous attempts of embolization), type I and II endoleak in 2 patients, and sac growth without imaging evidence of endoleak in the other 10. After the infrarenal aorta was prepared (via a retroperitoneal access, whenever possible), the technique consisted of performing a banding of the neck with Teflon (DuPont, Wilmington, Del), a sacotomy to remove the thrombus or the hygroma, or both, and then suturing all of the feeding vessels that were found. Proximal and distal fenestrations were performed to avoid sac repressurization.
  
  
  RESULTS
  The semiconversion was performed after a mean of 74 months after the initial EVAR. The mean aneurysm size at the time of the EVAR was 6.0 cm (range, 5.0-9.5 cm), and the mean aneurysm size at the time of the semiconversion was 7.7 cm (range, 5.5-11.5 cm). The overall aneurysm size increase was 38%, and the average growth rate was 8.2% per year. One patient had a stable aneurysm size but was treated because of an emergency condition. Technical success was 100%, with resolution of the endoleak and no perioperative deaths. Four cardiac deaths were registered at 12, 26, 30, and 60 months (mean follow-up, 42 months; range, 1-80 months).
  
  
  CONCLUSIONS
  Graft salvage appears to be a valid option compared with open repair when considering treatment of persistent type II endoleak. This case series shows that semiconversion is a safe and effective treatment for otherwise untreatable type II endoleak.
authors.affiliation: Vascular Surgery Department, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mangialardi
authors.affiliation: Vascular Surgery Department, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ronchey
authors.affiliation: Vascular Surgery Department, San Filippo Neri Hospital, Rome, Italy; Vascular Surgery Department, Policlinico Santa Maria alle Scotte, Siena, Italy. Electronic address: dr.orrico.matteo@gmail.com.
authors.forename: Matteo
authors.initials: M
authors.lastname: Orrico
authors.affiliation: Vascular Surgery Department, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Serrao
authors.affiliation: Vascular Surgery Department, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Alberti
authors.affiliation: Vascular Surgery Department, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fazzini
authors.affiliation: Vascular Surgery Unit, AOUP "P. Giaccone," University of Palermo, Palermo, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Pecoraro
authors.affiliation: Vascular Surgery Department, Policlinico Santa Maria alle Scotte, Siena, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Setacci
mesh_terms: D019917:Blood Vessel Prosthesis Implantation; D061887:Conversion to Open Surgery / Q000379:methods*; D057867:Endoleak / Q000453:epidemiology / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection