Alqahtani Saeed S, Aljaber Fahad K, Alsuwailem Bader Y, AlMashouq Yazeed A, Alharbi Bander G, Masoud Riyadh H, Albaqami Faisal A
Vascular Surgery, Charité - Universitätsmedizin Berlin, Berlin, DEU.
Vascular Surgery, Prince Sultan Military Medical City, Riyadh, SAU.
Cureus. 2024 Mar 30;16(3):e57271. doi: 10.7759/cureus.57271. eCollection 2024 Mar.
Endovascular aneurysm repair (EVAR) is a preferred treatment for abdominal aortic aneurysms, though it comes with complications such as endoleaks and graft infections that may necessitate late open conversion (LOC). This systematic review and meta-analysis, drawing on studies from PubMed/MEDLINE, Embase, and the Cochrane Database of Systematic Reviews, aimed to evaluate the incidence, outcomes, and factors leading to LOC after EVAR. The analysis of 11 selected studies revealed a 5.3% incidence of LOC, with a patient cohort predominantly male (79%) and an average age of 73.5 years. The interval between initial EVAR and LOC was 35.1 months on average, with the Excluder device most frequently necessitating LOC. A notable 68% of endovascular salvage attempts before LOC failed. The study highlighted rupture and type I endoleak as the primary reasons for urgent LOC, which exhibited a 10-fold higher mortality rate compared to elective LOC. Elective LOC procedures had a 30-day mortality rate similar to primary elective open aneurysm repairs. These findings underscore the importance of vigilant post-EVAR patient monitoring and suggest that the methodological quality of underlying research should be considered in interpreting these results.
血管内动脉瘤修复术（EVAR）是腹主动脉瘤的首选治疗方法，不过它会带来诸如内漏和移植物感染等并发症，这些并发症可能需要后期进行开放转换术（LOC）。本系统评价和荟萃分析利用了来自PubMed/MEDLINE、Embase和Cochrane系统评价数据库的研究，旨在评估EVAR术后LOC的发生率、结局及相关因素。对11项选定研究的分析显示，LOC的发生率为5.3%，患者队列中男性占主导（79%），平均年龄为73.5岁。初次EVAR与LOC之间的间隔平均为35.1个月，Excluder装置最常需要进行LOC。值得注意的是，68%的LOC前血管内挽救尝试失败。该研究强调破裂和I型内漏是紧急LOC的主要原因，与择期LOC相比，其死亡率高出10倍。择期LOC手术的30天死亡率与初次择期开放性动脉瘤修复术相似。这些发现强调了EVAR术后对患者进行密切监测的重要性，并表明在解释这些结果时应考虑基础研究的方法学质量。
