Abstract：
BACKGROUND: Late open conversion (LOC) following endovascular aneurysm repair (EVAR) is a rare complication with a high morbidity and mortality and is often proposed as the last line of treatment after failure of endovascular reintervention of any type. This study aimed to highlights the limitations of EVAR follow-up imaging in characterizing endoleaks, which may contribute to the failure of endovascular reinterventions and lead to LOC.
METHODS: This retrospective cohort study recruited all EVAR implanted in Amiens University Hospital (France) between January 2008 and December 2022. Elective LOC was defined as surgical conversion >1 month after EVAR. The primary endpoint was the rate of wrong categorization of endoleaks by follow-up exams before LOC. Secondary endpoints were the morbidity and the mortality associated with LOC.
RESULTS: Seven hundred eight EVARs were performed in our institution, 30 required elective LOC. Twenty-five of them were treated for sac enlargement due to an endoleak (83.3%) (all types). Wrong categorization of the endoleak was noted in 13 patients (52.2%). Twelve of these recategorizations involved the preoperative diagnosis of a type II endoleaks (92.3%). The change in categorization in 7 out of 12 cases (58%) was in favor of a type I endoleak, other recategorization included 1 type III (8%) and 4 type IV (33%). One patient died during the 30-day postoperative period and 7 patients (28%) presented a major complication; the median length of stay was 13 days (interquartile range 9-21).
CONCLUSIONS: Routine follow-up examinations such as angioscanner and contrast Doppler ultrasound appear to be limited in their ability to categorize the type of persistent endoleak, which may increase the number of patients requiring LOC. New precision diagnostic imaging techniques, such as dynamic examinations, need to be developed to limit the need for LOC.
METHODS: This retrospective cohort study recruited all EVAR implanted in Amiens University Hospital (France) between January 2008 and December 2022. Elective LOC was defined as surgical conversion >1 month after EVAR. The primary endpoint was the rate of wrong categorization of endoleaks by follow-up exams before LOC. Secondary endpoints were the morbidity and the mortality associated with LOC.
RESULTS: Seven hundred eight EVARs were performed in our institution, 30 required elective LOC. Twenty-five of them were treated for sac enlargement due to an endoleak (83.3%) (all types). Wrong categorization of the endoleak was noted in 13 patients (52.2%). Twelve of these recategorizations involved the preoperative diagnosis of a type II endoleaks (92.3%). The change in categorization in 7 out of 12 cases (58%) was in favor of a type I endoleak, other recategorization included 1 type III (8%) and 4 type IV (33%). One patient died during the 30-day postoperative period and 7 patients (28%) presented a major complication; the median length of stay was 13 days (interquartile range 9-21).
CONCLUSIONS: Routine follow-up examinations such as angioscanner and contrast Doppler ultrasound appear to be limited in their ability to categorize the type of persistent endoleak, which may increase the number of patients requiring LOC. New precision diagnostic imaging techniques, such as dynamic examinations, need to be developed to limit the need for LOC.
摘要：
背景：血管内动脉瘤修复术（EVAR）后的晚期开放转换（LOC）是一种罕见的并发症，具有很高的发病率和死亡率，通常被建议作为任何类型的血管内再介入失败后的最后治疗路线。这项研究旨在强调EVAR随访成像在表征内漏的局限性，这可能导致血管内再干预失败并导致LOC。
方法：这项回顾性队列研究招募了2008年1月至2022年12月在法国亚眠大学医院植入的所有EVAR。选择性LOC定义为EVAR后>1个月的手术转换。主要终点是LOC前随访检查内漏错误分类率。次要终点是与LOC相关的发病率和死亡率。
结果：在我们的机构中进行了七百零八次EVAR，30所需的选修LOC。其中25例由于内漏（83,3％）（所有类型）进行了囊扩大治疗。在13名患者中发现了错误的内漏分类(52.2%)。这些重新分类中有12项涉及II型内漏的术前诊断（92.3％）。12例病例中有7例(58%)的分类变化有利于I型内漏，其他重新分类包括1个III类(8%)，4种类型IV（33%）。1例患者在术后30天内死亡，7例患者（28%）出现严重并发症，中位住院时间为13天(IQR9-21).
结论：常规随访检查，如血管扫描仪和多普勒超声造影，对持续性内漏类型进行分类的能力有限，这可能会增加需要LOC的患者数量。新的精密诊断成像技术，如动态考试，需要开发以限制对LOC的需求。
方法：这项回顾性队列研究招募了2008年1月至2022年12月在法国亚眠大学医院植入的所有EVAR。选择性LOC定义为EVAR后>1个月的手术转换。主要终点是LOC前随访检查内漏错误分类率。次要终点是与LOC相关的发病率和死亡率。
结果：在我们的机构中进行了七百零八次EVAR，30所需的选修LOC。其中25例由于内漏（83,3％）（所有类型）进行了囊扩大治疗。在13名患者中发现了错误的内漏分类(52.2%)。这些重新分类中有12项涉及II型内漏的术前诊断（92.3％）。12例病例中有7例(58%)的分类变化有利于I型内漏，其他重新分类包括1个III类(8%)，4种类型IV（33%）。1例患者在术后30天内死亡，7例患者（28%）出现严重并发症，中位住院时间为13天(IQR9-21).
结论：常规随访检查，如血管扫描仪和多普勒超声造影，对持续性内漏类型进行分类的能力有限，这可能会增加需要LOC的患者数量。新的精密诊断成像技术，如动态考试，需要开发以限制对LOC的需求。
