Twenty-three Years of Experience in Aortic Endograft Explantation

Twenty-three Years of Experience in Aortic Endograft Explantation Francesca Miceli, MD, PhD,1 Simone Cuozzo, MD, PhD,1 Vincenzo Brizzi, MD, FEBVS,2 Ombretta Martinelli, MD,1 Enrico Sbarigia, MD1 . 1 Sapienza, Rome, Italy; 2 Centre Hospitalier Universitaire, Bordeaux, France Objective: Late open conversion (LOC) after failed endovascular aneurysm repair (EVAR) still represents one of the major challenges in the endovascular era. We aim to evaluate rates and indications, and periand long- term out-patient mortality of aortic endograft explantation. Methods: Analysis was performed on a retrospective monocentric database of patients who underwent LOC for aortic endograft failure. Patients were stratified into two groups according to the etiology of endograft explantation: endoleak (EL) versus aortic endograft infection (AEGI). We distinguished the 30-day mortality rate between urgent and elective LOC procedures. Results: Over a period of 23 years (January 2000eMarch 2023), 2,458 standard EVAR procedures were performed at our University Hospital Center. Thirty-four stent-graft explants were performed with an explantation rate of 1.4%. The mean age at explantation was 71.5 6 7.3 years (range, 56e85). The overall average length of time from EVAR to LOC was 43.7 6 37.6 months (range, 0.7e147.4). Sixteen patients (47.1%) underwent explant for endoleak. Of those, 12 (75%) were in an elective setting, and 4 (25%) in an urgent setting. In the remaining 18 cases, seventeen patients (50%) underwent LOC for infection, four of which (23,5%) were in an urgent setting (Table 1). Overall mean follow-up time after explantation was 57.1 6 59.8 months (range, 0.2e190.8). The overall 30-day perioperative mortality rate was 26.5% (EL 31.2%; AEGI 23.5%). The pooled estimate for 30-day mortality rate was 13.3% for elective- and 87.5% for urgent LOC (p < .001), beyond the etiology of stent- graft explantation (Fig. 1). Conclusion: Our study confirms that the incidence of LOC after EVAR is rare, but is associated with poor outcomes, especially in the urgent setting. Author Disclosure: F. Miceli: Nothing to disclose. Table. Reasons for endograft failure and type of setting for late open conversion Total (%) (N¼34) Elective setting No. (%) Urgent setting No. (%) Endoleak 16 (47.1) 12 (75) 4 (25) Type IA 8/16 (50) 5/8 (62.5) 3/8 (37.5) Type II 6/16 (37.5) 5/6 (83.3) 1/6 (16.7) Type III 2/16 (12.5) 2/2 (100) - Infection 17 (50.0) 13 (76.5) 4 (23.5) Thrombosis 1 (2.9) - 1 (100) Fig. 30-day mortality was significantly higher in those patients treated in an urgent setting, beyond the etiology of stent-graft explantation