Late surgical conversions after endoprosthetic repair of abdominal aortic aneurysms

• Abrosimov A.A.
• Yamenskov V.V.
• Obraztsov A.V.
• Pinchuk O.V.
• Ivanov A.V.

Abstract

Background. Unsatisfactory results of open operations after endoprosthetic repair of abdominal aortic aneurysms are mainly due to technical difficulties of the intervention and associated with a longer time of aortic cross-clamping and a higher frequency of visceral complications.

Objective. The purpose of this study was to investigate the causes of performing late open operations and their results after endoprosthetic repair of abdominal aortic aneurysms.

Patients and methods. We retrospectively analyzed remote outcomes in a total of 82 patients after endoprosthetic repair of abdominal aortic aneurysms, carried out from 2012 to 2022 at the National Medical Research Center of High Medical Technologies – Central Military Clinical Hospital named after A.A. Vishnevsky. Long-term complications developed in 33 (40.2%) patients. Endoleaks turned out to be the most frequent complications encountered in 26 (31.7%) cases. Sixteen (19.5%) patients required repeat surgical interventions. Open surgical conversion was carried out in five (6.1%) patients.

Results. During late conversions performed emergently for a ruptured aneurysm, two patients died. There were no lethal outcomes in elective interventions. The indications for late conversion in all cases were endoleaks with an increased size or rupture of the aneurysm. Described in the article is a clinical case report regarding successful treatment of a patient with type II endoleak combined with endoprosthesis branch thrombosis and clinical manifestations of critical ischemia of the left lower limb. During open surgery, instead of an aortic cross-clamp we used an occluding aortic balloon placed above the proximal edge of the stent graft.

Conclusion. An indication for open surgery in the remote period after EVAR is most often an endoleak associated with an increased-size aneurysm and impossibility to perform endovascular correction.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Yamenskov V.V., Obraztsov A.V., Pinchuk O.V.; data collection and handling – Abrosimov A.A., Yamenskov V.V.; statistical processing – Abrosimov A.A., Ivanov A.V.; draft manuscript preparation – Abrosimov A.A., Yamenskov V.V.; manuscript revision – Pinchuk O.V., Obraztsov A.V.

For citation: Abrosimov A.A., Yamenskov V.V., Obraztsov A.V., Pinchuk O.V., Ivanov A.V. Late surgical conversions after endoprosthetic repair of abdominal aortic aneurysms. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 88–94. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-88-94

Keywords:abdominal aortic aneurysm; endoprosthetic repair; endoleak; late complications; open surgery