{Reference Type}: Journal Article
{Title}: Endograft Thrombosis as indication for Open Conversion after EVAR in a multicenter experience over 25 years.
{Author}: Fornasari A;Perini P;Gargiulo M;Silingardi R;Michelagnoli S;Bonardelli S;Bellosta R;Freyrie A; ;
{Journal}: Ann Vasc Surg
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jun 27
{Factor}: 1.607
{DOI}: 10.1016/j.avsg.2024.04.018
{Abstract}: <B>OBJECTIVE: </B>To describe the outcomes of aortic endograft thrombosis (AET) as an indication for open conversion (OC) after endovascular aortic aneurysm repair (EVAR) in a multicenter experience.<BR><B>METHODS: </B>This study retrospectively analyzed cases of OC for AET following EVAR across 12 Italian Vascular Surgery centers from 1997 to September 2022. The endpoints were as follows: 30-days mortality and major postoperative complications. Follow-up data included: survival and aortic-related complications.<BR><B>RESULTS: </B>Sixteen patients (mean age: 68.6±8.5 years) were included. Median elapsed time between EVAR to OC was 26.46 months (IQR 13.8-45.9). Proximal aortic cross-clamping site was supraceliac in 8 out of 16 (50%) patients, complete removal of the stentgraft was achieved in 75% of cases (12/16 patients). Reconstructions were: aorto-bi-iliac grafts in 8 cases (50%), 7 aorto-bi-femoral bypass grafts (43.8%), and 1 aorto-aortic tube graft (6.3%). All patients were symptomatic at presentation (68.7% unilateral acute limb ischemia, 25% bilateral acute limb ischemia, 1 patient had chronic severe claudication). Thirty-day mortality was 12.5% (2/16 patients). Overall morbidity rate was 43.8% (7 of 16 patients). No specific risk factors for early mortality were found. The overall estimated survival rate was 80.4% at 1 year, 62.5% at 2 years and 41.7% at 3 years.<BR><B>CONCLUSIONS: </B>OC for AET is typically reserved for complex cases that are not amenable to endovascular solutions. The frequent need for suprarenal clamping and complete endograft removal seem to be associated with high short-term mortality.