Millon A, Deelchand A, Feugier P, Chevalier J M, Favre J P
Department of Vascular Surgery, University Hospital of Lyon, Lyon, France.
Eur J Vasc Endovasc Surg. 2009 Oct;38(4):429-34. doi: 10.1016/j.ejvs.2009.06.001. Epub 2009 Jul 9.
To evaluate the causes and results of conversion to open repair after aortic aneurysm endovascular treatment (EVAR).
Retrospective study of open conversion after EVAR was performed in eight French academic centres. Primary conversion (PC) within 30 days after EVAR and secondary conversions (SC) were analysed separately.
Between 1997 and 2007, open conversions were performed in 34 patients (most often in high-risk patients): 14 PC and 20 SC. Two main causes of PC were unfavourable iliac artery anatomy and renal artery coverage. In hospital mortality was 21%. SC occurred at a median of 44 months after primary EVAR. Nine were urgent cases for rupture or infection and 11 elective for aneurysm growth, infection or thrombosis. Early mortality was similar after emergent or elective SC (25%).
Open conversion, and, in particular, PC and urgent SC, was associated with a poor outcome. According to the literature, mortality after elective SC is low but remains high in high-risk patients.
评估腹主动脉瘤腔内治疗（EVAR）后转为开放修复术的原因及结果。
对法国八个学术中心进行的EVAR术后开放转换进行回顾性研究。分别分析了EVAR术后30天内的初次转换（PC）和二次转换（SC）。
1997年至2007年期间，34例患者进行了开放转换（大多数为高危患者）：14例PC和20例SC。PC的两个主要原因是髂动脉解剖结构不佳和肾动脉覆盖。住院死亡率为21%。SC发生在初次EVAR术后的中位时间为44个月。9例为破裂或感染的紧急病例，11例为动脉瘤生长、感染或血栓形成的择期病例。紧急或择期SC后的早期死亡率相似（25%）。
开放转换，尤其是PC和紧急SC，与不良结局相关。根据文献，择期SC后的死亡率较低，但高危患者中死亡率仍然较高。
