Delayed open conversion following endovascular aortoiliac aneurysm repair: Partial (or complete) endograft preservation as a useful adjunct

Evan C. Lipsitz, Takao Ohki, Frank J. Veith, William D. Suggs, Reese A. Wain, Soo J. Rhee, Nicholas J. Gargiulo, Jamie McKay, Ronald M. Fairman, Dhiraj M. Shah, Daniel G. Clair, Jeffrey P. Carpenter, Peter L. Faries, Manish Mehta

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to review our experience with delayed open conversion (> 30 days) following endovascular aortoiliac aneurysm repair (EVAR) and to introduce the concept and advantages of endograft retention in this setting. Methods: From January 1992 to January 2003, a total of 386 EVARs using a variety of endografts were successfully deployed. Eleven (2.8%) patients required delayed conversion to open repair at an average of 30 months (range, 10-64). Data from all patients undergoing both EVAR and open conversion were prospectively collected. Results: EVARs were performed using grafts made by Talent (4), Vanguard (2,) AneuRx (1), and Surgeon (4). Conversion to open repair (9 transabdominal, 1 retroperitoneal, 1 transabdominal plus thoracotomy) was performed for aneurysm rupture in 7 patients (4 type 1 endoleak, 2 type 2 endoleak, 1 aortoenteric fistula) and aneurysm enlargement in 4 patients (1 type 1 endoleak, 1 type 2 endoleak, 1 type 3 endoleak, 1 endotension). Patients with aneurysm rupture were treated on an emergent basis. Complete removal of the endograft with supraceliac cross-clamping was performed in two cases. One patient (rupture) did not survive the operation, and one patient (aortoenteric fistula) died 2 weeks postoperatively. In the remaining nine cases, the endograft was either completely (1) or partially (6) removed, or left in situ (2). Supraceliac balloon control (2), supraceliac clamping (1), suprarenal clamping (1), or infrarenal clamping (5) was used in these cases. All nine of these patients survived the operation. In one procedure in which the endograft was left intact (endotension), repair was accomplished by exposing the endograft and by placing a standard tube graft over it as a sleeve. In the second procedure in which the graft was left in situ (rupture), the graft was well incorporated, and bleeding lumbar arteries were oversewn and the sac was closed tightly over the endograft. In the remaining 7 cases, the endograft was transected and the proximal portion only (6) or the proximal and distal portions (1) were excised. All surviving patients continue to do well and remain without complications associated with the endograft remnant at a mean follow-up of 22 months (range, 3-56) from the time of open conversion and 46 months (range, 10-73) from the time of original EVAR. Conclusions: Open repair in the setting of a long-standing endograft offers several unique technical challenges but can be successfully accomplished in most patients. Preservation of all of part of the endograft is possible in many patients. This technique simplifies the operative approach and is preferred over complete endograft removal if possible.

Original languageEnglish (US)
Pages (from-to)1191-1198
Number of pages8
JournalJournal of Vascular Surgery
Volume38
Issue number6
DOIs
StatePublished - Dec 2003

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Aneurysm
Endoleak
Constriction
Rupture
Transplants
Fistula
Aptitude
Thoracotomy
Arteries
Hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Delayed open conversion following endovascular aortoiliac aneurysm repair : Partial (or complete) endograft preservation as a useful adjunct. / Lipsitz, Evan C.; Ohki, Takao; Veith, Frank J.; Suggs, William D.; Wain, Reese A.; Rhee, Soo J.; Gargiulo, Nicholas J.; McKay, Jamie; Fairman, Ronald M.; Shah, Dhiraj M.; Clair, Daniel G.; Carpenter, Jeffrey P.; Faries, Peter L.; Mehta, Manish.

In: Journal of Vascular Surgery, Vol. 38, No. 6, 12.2003, p. 1191-1198.

Research output: Contribution to journalArticle

Lipsitz, EC, Ohki, T, Veith, FJ, Suggs, WD, Wain, RA, Rhee, SJ, Gargiulo, NJ, McKay, J, Fairman, RM, Shah, DM, Clair, DG, Carpenter, JP, Faries, PL & Mehta, M 2003, 'Delayed open conversion following endovascular aortoiliac aneurysm repair: Partial (or complete) endograft preservation as a useful adjunct', Journal of Vascular Surgery, vol. 38, no. 6, pp. 1191-1198. https://doi.org/10.1016/j.jvs.2003.09.012
Lipsitz, Evan C. ; Ohki, Takao ; Veith, Frank J. ; Suggs, William D. ; Wain, Reese A. ; Rhee, Soo J. ; Gargiulo, Nicholas J. ; McKay, Jamie ; Fairman, Ronald M. ; Shah, Dhiraj M. ; Clair, Daniel G. ; Carpenter, Jeffrey P. ; Faries, Peter L. ; Mehta, Manish. / Delayed open conversion following endovascular aortoiliac aneurysm repair : Partial (or complete) endograft preservation as a useful adjunct. In: Journal of Vascular Surgery. 2003 ; Vol. 38, No. 6. pp. 1191-1198.
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abstract = "Objectives: The purpose of this study was to review our experience with delayed open conversion (> 30 days) following endovascular aortoiliac aneurysm repair (EVAR) and to introduce the concept and advantages of endograft retention in this setting. Methods: From January 1992 to January 2003, a total of 386 EVARs using a variety of endografts were successfully deployed. Eleven (2.8{\%}) patients required delayed conversion to open repair at an average of 30 months (range, 10-64). Data from all patients undergoing both EVAR and open conversion were prospectively collected. Results: EVARs were performed using grafts made by Talent (4), Vanguard (2,) AneuRx (1), and Surgeon (4). Conversion to open repair (9 transabdominal, 1 retroperitoneal, 1 transabdominal plus thoracotomy) was performed for aneurysm rupture in 7 patients (4 type 1 endoleak, 2 type 2 endoleak, 1 aortoenteric fistula) and aneurysm enlargement in 4 patients (1 type 1 endoleak, 1 type 2 endoleak, 1 type 3 endoleak, 1 endotension). Patients with aneurysm rupture were treated on an emergent basis. Complete removal of the endograft with supraceliac cross-clamping was performed in two cases. One patient (rupture) did not survive the operation, and one patient (aortoenteric fistula) died 2 weeks postoperatively. In the remaining nine cases, the endograft was either completely (1) or partially (6) removed, or left in situ (2). Supraceliac balloon control (2), supraceliac clamping (1), suprarenal clamping (1), or infrarenal clamping (5) was used in these cases. All nine of these patients survived the operation. In one procedure in which the endograft was left intact (endotension), repair was accomplished by exposing the endograft and by placing a standard tube graft over it as a sleeve. In the second procedure in which the graft was left in situ (rupture), the graft was well incorporated, and bleeding lumbar arteries were oversewn and the sac was closed tightly over the endograft. In the remaining 7 cases, the endograft was transected and the proximal portion only (6) or the proximal and distal portions (1) were excised. All surviving patients continue to do well and remain without complications associated with the endograft remnant at a mean follow-up of 22 months (range, 3-56) from the time of open conversion and 46 months (range, 10-73) from the time of original EVAR. Conclusions: Open repair in the setting of a long-standing endograft offers several unique technical challenges but can be successfully accomplished in most patients. Preservation of all of part of the endograft is possible in many patients. This technique simplifies the operative approach and is preferred over complete endograft removal if possible.",
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T1 - Delayed open conversion following endovascular aortoiliac aneurysm repair

T2 - Partial (or complete) endograft preservation as a useful adjunct

AU - Lipsitz, Evan C.

AU - Ohki, Takao

AU - Veith, Frank J.

AU - Suggs, William D.

AU - Wain, Reese A.

AU - Rhee, Soo J.

AU - Gargiulo, Nicholas J.

AU - McKay, Jamie

AU - Fairman, Ronald M.

AU - Shah, Dhiraj M.

AU - Clair, Daniel G.

AU - Carpenter, Jeffrey P.

AU - Faries, Peter L.

AU - Mehta, Manish

PY - 2003/12

Y1 - 2003/12

N2 - Objectives: The purpose of this study was to review our experience with delayed open conversion (> 30 days) following endovascular aortoiliac aneurysm repair (EVAR) and to introduce the concept and advantages of endograft retention in this setting. Methods: From January 1992 to January 2003, a total of 386 EVARs using a variety of endografts were successfully deployed. Eleven (2.8%) patients required delayed conversion to open repair at an average of 30 months (range, 10-64). Data from all patients undergoing both EVAR and open conversion were prospectively collected. Results: EVARs were performed using grafts made by Talent (4), Vanguard (2,) AneuRx (1), and Surgeon (4). Conversion to open repair (9 transabdominal, 1 retroperitoneal, 1 transabdominal plus thoracotomy) was performed for aneurysm rupture in 7 patients (4 type 1 endoleak, 2 type 2 endoleak, 1 aortoenteric fistula) and aneurysm enlargement in 4 patients (1 type 1 endoleak, 1 type 2 endoleak, 1 type 3 endoleak, 1 endotension). Patients with aneurysm rupture were treated on an emergent basis. Complete removal of the endograft with supraceliac cross-clamping was performed in two cases. One patient (rupture) did not survive the operation, and one patient (aortoenteric fistula) died 2 weeks postoperatively. In the remaining nine cases, the endograft was either completely (1) or partially (6) removed, or left in situ (2). Supraceliac balloon control (2), supraceliac clamping (1), suprarenal clamping (1), or infrarenal clamping (5) was used in these cases. All nine of these patients survived the operation. In one procedure in which the endograft was left intact (endotension), repair was accomplished by exposing the endograft and by placing a standard tube graft over it as a sleeve. In the second procedure in which the graft was left in situ (rupture), the graft was well incorporated, and bleeding lumbar arteries were oversewn and the sac was closed tightly over the endograft. In the remaining 7 cases, the endograft was transected and the proximal portion only (6) or the proximal and distal portions (1) were excised. All surviving patients continue to do well and remain without complications associated with the endograft remnant at a mean follow-up of 22 months (range, 3-56) from the time of open conversion and 46 months (range, 10-73) from the time of original EVAR. Conclusions: Open repair in the setting of a long-standing endograft offers several unique technical challenges but can be successfully accomplished in most patients. Preservation of all of part of the endograft is possible in many patients. This technique simplifies the operative approach and is preferred over complete endograft removal if possible.

AB - Objectives: The purpose of this study was to review our experience with delayed open conversion (> 30 days) following endovascular aortoiliac aneurysm repair (EVAR) and to introduce the concept and advantages of endograft retention in this setting. Methods: From January 1992 to January 2003, a total of 386 EVARs using a variety of endografts were successfully deployed. Eleven (2.8%) patients required delayed conversion to open repair at an average of 30 months (range, 10-64). Data from all patients undergoing both EVAR and open conversion were prospectively collected. Results: EVARs were performed using grafts made by Talent (4), Vanguard (2,) AneuRx (1), and Surgeon (4). Conversion to open repair (9 transabdominal, 1 retroperitoneal, 1 transabdominal plus thoracotomy) was performed for aneurysm rupture in 7 patients (4 type 1 endoleak, 2 type 2 endoleak, 1 aortoenteric fistula) and aneurysm enlargement in 4 patients (1 type 1 endoleak, 1 type 2 endoleak, 1 type 3 endoleak, 1 endotension). Patients with aneurysm rupture were treated on an emergent basis. Complete removal of the endograft with supraceliac cross-clamping was performed in two cases. One patient (rupture) did not survive the operation, and one patient (aortoenteric fistula) died 2 weeks postoperatively. In the remaining nine cases, the endograft was either completely (1) or partially (6) removed, or left in situ (2). Supraceliac balloon control (2), supraceliac clamping (1), suprarenal clamping (1), or infrarenal clamping (5) was used in these cases. All nine of these patients survived the operation. In one procedure in which the endograft was left intact (endotension), repair was accomplished by exposing the endograft and by placing a standard tube graft over it as a sleeve. In the second procedure in which the graft was left in situ (rupture), the graft was well incorporated, and bleeding lumbar arteries were oversewn and the sac was closed tightly over the endograft. In the remaining 7 cases, the endograft was transected and the proximal portion only (6) or the proximal and distal portions (1) were excised. All surviving patients continue to do well and remain without complications associated with the endograft remnant at a mean follow-up of 22 months (range, 3-56) from the time of open conversion and 46 months (range, 10-73) from the time of original EVAR. Conclusions: Open repair in the setting of a long-standing endograft offers several unique technical challenges but can be successfully accomplished in most patients. Preservation of all of part of the endograft is possible in many patients. This technique simplifies the operative approach and is preferred over complete endograft removal if possible.

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