Late Open Conversion (LOC) for Endoleaks after EVAR

Abstract

Objective: To discuss surgical procerdure of cases who required late open conversion (LOC) for endoleaks (EL) with aneurysmal sac expansion. Methods: Between January 2007 and August 2017, 185 EVARs were performed for Abdominal Aortic Aneurysm (AAA) in our hospital. We report surgical procerdure of six caces (3.2%) who required LOC for endoleaks. Results: In 3 cases (Type Ia/Type II/Type Ia+II; 1/1/1), a stent graft (SG) was completely explanted and graft replacement was performed. In residual 3 cases, SG was preserved. We performed proximal neck banding for one patient with type Ia EL, laparotomy and ligation of inferior mesenteric artery for one patient with type II EL, fibrin spray to SG and plication of aneurysmal sac for one patient with type V EL. Complete removal of SG and graft replacement was more invasive than preservation of SG, regarding operative time, amount of bleeding and postoperative hospital stay. Conclusion: Complete removal of SG and graft replacement is a large invasive and a poor early postoperative results, so we consider that less invasive preservation of SG is more appropriate.