Late open conversion: a reliable solution for endoleak management after endovascular aortic aneurysm repair – a single center experience and literature review
Authors:   Clinic of Vascular and Endovascular Surgery, St. Josef Hospital, Ruhr-University of Bochum, Germany (former affiliation at the time of the study); Clinic of Vascular Surgery, Emergency County Clinical Hospital, Cluj-Napoca, Romania, Coman Horaţiu Flaviu , Andercou Octavian Aurel ,   Department of General Surgery, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Stancu Bogdan ,   Second Department of Surgery, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Ciocan Răzvan Alexandru ,   Department of Surgery–Practical Abilities, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Gherman Claudia Diana ,   Department of Surgery–Practical Abilities, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Trif Ana ,   Department of Vascular Surgery, Nicolae Stăncioiu Heart Institute, Cluj-Napoca, Romania, Farran Moustafa ,   Department of Vascular Surgery, Nicolae Stăncioiu Heart Institute, Cluj-Napoca, Romania, Haldenwang Peter Lukas ,   Department for Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr-University of Bochum, Germany, Răşcanu Claudiu George ,   Clinic of Vascular and Endovascular Surgery, Evangelical Hospital Düsseldorf, Germany
Published: February 2025

Background/Objectives: Despite the efficacy of endovascular approaches for most secondary interventions post-endovascular aortic aneurysm repair (EVAR), a small proportion of patients need open conversion (OC) procedures. We shared our experience regarding patient outcomes after late OCs post-EVAR. We also performed a literature review of data published on this topic. Patients, Materials and Methods: Medical records of patients who underwent late OCs post-EVAR at a Public Hospital in Germany (2017–2019) were retrospectively analyzed. OC involved total or partial endograft removal followed by aortic reconstruction. Preoperative patients’ characteristics, indications for OC, and intra-/post-operative outcomes were assessed. Studies published in English (2014–2024) on OCs post-EVAR complications were descriptively analyzed. Results: Six patients underwent late OCs throughout the study (males: 66.67%; age [mean±standard deviation]: 66.50±2.89 years). Grafts were excised after a median of 72 months (range: 24–132 months), with 2/6 (33.33%) urgent removals and 4/6 (66.67%) elective. 4/6 (66.67%) patients underwent complete removal, and 2/6 (33.33%) were partial. Clamping site was suprarenal in 3/6 (50.00%) patients, supraceliac in 2/6 (33.33%), and infrarenal in 1/6 (16.67%). Technical success was 100%, with 32 minutes mean clamping time and 1.67 L blood loss. Median follow-up was 13 months. No aneurysm growth was observed, and implanted grafts functioned well. 1/6 (16.67%) patients died during the postoperative intensive care unit stay. Seven studies were included in our review. The 30-day mortality post-OCs was 6.2–10.0% in elective setting and up to 40% in urgent. Conclusions: Late OC can be a reliable procedure for managing endoleak post-EVAR. Its success relies on accurate preoperative assessment and surgical expertise.