Surgical Conversion of Abdominal Aortic Stent-grafts—Outcome and Technical Considerations

Abstract

Objective The purpose of this study was to evaluate the outcome of patients with stented abdominal aortic aneurysms who had to undergo open aneurysm repair with partial or total stent-graft removal. Methods Between October 1996 and December 2003, 117 patients with abdominal aortic aneurysms underwent endovascular repair. When open surgery was necessary during the initial and same anaesthesia as stent-graft implantation, it was defined as immediate conversion. When conversion was performed during a second anaesthesia, we defined it as late (acute or elective) conversion. Results A total of 33 patients underwent conversion to open surgery. In 7 (6%) patients, immediate conversion was necessary due to stent-graft misplacement and obstruction of the renal arteries ( n=4), type Ia endoleaks ( n=2) and stent-graft dislocation into the aneurysm sac ( n=1). During a mean follow-up period of 39.6 months (min 0.03 months, max 80.4 months), 26 (23.6%) of the remaining 110 patients underwent late conversion to open surgery for endoleak ( n=12), rupture ( n=6), thrombosis ( n=4), graft fatigue ( n=2), aorto-duodenal fistula ( n=1), and recurring peripheral embolisms ( n=1). The mortality of acute conversion was 38% (5 of 13). Elective conversion did not lead to any mortality. Conclusion Acute conversion of stented abdominal aortic aneurysms is associated with a high mortality. Elective stent-graft explantation with open aortic reconstruction is a safe but complex procedure.