Nomura Yoshikatsu, Nagao Kanetsugu, Hasegawa Shota, Kawashima Motoharu, Tsujimoto Takanori, Izumi So, Matsumori Masamichi, Tanaka Hiroshi, Murakami Hirohisa, Honda Tasuku, Kawasaki Ryota, Mukohara Nobuhiko
Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan.
Department of Radiology, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan.
Ann Vasc Dis. 2019 Sep 25;12(3):340-346. doi: 10.3400/avd.oa.19-00009.
: To review our experience with a late open conversion as a final option for an endograft infection and aneurysm expansion after endovascular aneurysm repair (EVAR), especially in endoleaks for which radiological intervention is impossible. : In this retrospective study, 13 late open conversions out of 513 consecutive patients treated by EVAR were analyzed. Indications for an open conversion were aneurysm enlargement, including all endoleaks, endograft migration, and endograft infection. The patients' data on demographics, operative details, and outcomes were reviewed. : Indications for a late open conversion included endoleaks, infection, and migration in 61.5%, 30.8%, and 7.7% of patients, respectively. The median interval from the initial EVAR was 32.4 months. Complete endograft explantation was performed in four patients with an endograft infection. In endoleak cases, the endograft was partially preserved and a neo-neck was used. Sacotomy and branch ligation were performed in one case. One major operative complication was an aortic injury during infrarenal aortic cross-clamping in an endograft migration case. There was no operative mortality. : A late open conversion after EVAR is valuable as a final option. The aortic cross-clamp site, especially in endograft migration cases, should be carefully considered. To avoid aneurysm-related events, graft replacement is recommended, if possible.
回顾我们将晚期开放转换作为血管内动脉瘤修复术（EVAR）后内移植物感染和动脉瘤扩张的最终选择的经验，尤其是在无法进行放射学干预的内漏情况下。在这项回顾性研究中，分析了连续接受EVAR治疗的513例患者中的13例晚期开放转换病例。开放转换的指征包括动脉瘤扩大，包括所有内漏、内移植物移位和内移植物感染。回顾了患者的人口统计学数据、手术细节和结局。晚期开放转换的指征分别包括61.5%的患者存在内漏、30.8%的患者存在感染和7.7%的患者存在移位。从初次EVAR到开放转换的中位间隔时间为32.4个月。4例内移植物感染患者进行了完全内移植物取出术。在内漏病例中，部分保留内移植物并使用了新的颈部。1例患者进行了瘤囊切开术和分支结扎。1例主要手术并发症是在内移植物移位病例中，肾下腹主动脉交叉阻断期间发生主动脉损伤。无手术死亡病例。EVAR术后晚期开放转换作为最终选择是有价值的。应仔细考虑主动脉交叉阻断部位，尤其是在内移植物移位病例中。为避免动脉瘤相关事件，如有可能，建议进行移植物置换。
