Marone Enrico M, Rinaldi Luigi F, Lovotti Maurizio, Palmieri Piernicola
Vascular Surgery Division, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Teaching Hospital IRCCS Policlinico San Matteo, Pavia, Italy.
Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
Ann Vasc Surg. 2020 Aug;67:546-552. doi: 10.1016/j.avsg.2020.02.024. Epub 2020 Mar 20.
Open conversion of endovascular aortic repair (EVAR) is the first-choice treatment in case of endograft failure or high-flow endoleak. However, the traditional technique based on the total removal of the endograft can produce injuries of the aortic walls, with severe consequences on the anastomoses quality. Our aim is to show the advantages of the partial endograft removal on the aortic integrity by reporting a case series including 25 delayed open conversion performed with this technique.
A retrospective study was conducted over the cases of delayed open conversions performed in the last 30 months. Demographics, past medical history, endograft type, causes for conversions, and early and mid-term outcomes were recorded and analyzed in relation with the technique employed (partial vs total endograft removal).
Between September 2016 and March 2019, 25 consecutive cases of EVAR failure were converted to open treatment. In all cases, the endografts were resected leaving in place part of the iliac branches, and, whenever possible, also the proximal stent of the main body. Primary technical success was achieved in 100% of cases. Disease-free survival over 18-month median follow-up was 100%. All patients underwent abdominal aortic duplex scan controls as scheduled, with no early or late postoperative complication. No anastomotic aneurysms or any surgery-related complications were observed.
Partial endograft removal is a safe and effective technique that could be used to protect the aortic integrity in delayed open conversions of EVAR.
对于血管腔内主动脉修复术（EVAR）失败或存在高流量内漏的情况，开放式转换是首选治疗方法。然而，基于完全移除血管内移植物的传统技术可能会损伤主动脉壁，对吻合质量产生严重影响。我们的目的是通过报告一组25例采用该技术进行的延迟开放式转换病例系列，展示部分移除血管内移植物对主动脉完整性的优势。
对过去30个月内进行的延迟开放式转换病例进行回顾性研究。记录并分析人口统计学、既往病史、血管内移植物类型、转换原因以及与所采用技术（部分与完全移除血管内移植物）相关的早期和中期结果。
2016年9月至2019年3月期间，连续25例EVAR失败病例转换为开放式治疗。在所有病例中，血管内移植物被切除，保留部分髂支，并且只要可能，也保留主体的近端支架。所有病例均取得了初步技术成功。在中位随访18个月期间，无病生存率为100%。所有患者均按计划接受了腹主动脉双功超声扫描检查，术后无早期或晚期并发症。未观察到吻合口动脉瘤或任何与手术相关的并发症。
部分移除血管内移植物是一种安全有效的技术，可用于在EVAR延迟开放式转换中保护主动脉完整性。
