Results of open conversion with full endograft explantation after failed EVAR

BACKGROUND: The aim of this study was to analyze open conversion (OC) after failed endovascular aortic repair (EVAR) and to identify predictors of postoperative mortality. METHODS: It is a single-center, retrospective, observational cohort study of the patients treated between January 1, 1997, and April 30, 2021. Post-hoc analysis recruited only patients who underwent OC with full endograft (EG) explantation because of failed EVAR. Specifically for this study, primary endpoint of interest was early (<30 days) mortality. RESULTS: Twenty-seven patients 27 out of 1051 (2.6%) underwent OC were identified. There were 24 (88.9%) males and 3 females: median age at the time of OCwas 72 years (IQR: 67-79). Open conversion was performed after a median interval of 11 months (IQR: 0-62) from initial EVAR. Eleven (40.7%) patients were operated on urgently (rupture, N.=8). Overall, 30-day mortality rate was 25.9% (N.=7). Binary logistic regression analysis confirmed that rupture at admission was predictive of 30-day mortality (OR=14, 95% CI: 1.8-109.9, P=0.011). The mean follow-up of survivors was 38 months (range: 1-151): overall estimated survival rate was 79±0.8% at 12 months (95% CI: 59.3-89.4), 70±0.9% at 36 months (95% CI: 51.5-84.2), and 63±1% at 60 months (95% CI: 41.3-80). CONCLUSIONS: In our experience, a non-negligible rate of patients requiring OCafter failed EVARpresented with rupture which was the only predictor of early mortality.