{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T17:13:34Z","timestamp":1760202814356,"version":"3.37.3"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2019,8,29]],"date-time":"2019-08-29T00:00:00Z","timestamp":1567036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p\/><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Our goal was to report our results of late surgical conversion after endovascular aneurysm repair (EVAR).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Variables analysed included baseline data, preinterventional anatomy, type of endovascular intervention, indications for conversion, operative technique, postoperative complications and follow-up survival rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Between April 2011 and May 2018, 16 patients with late complications after EVAR underwent open surgical conversion at our institution. The mean age was 73.6 [standard deviation (SD) 8.9] years. There were 3 (18.8%) female patients. In 15 patients, the indication for primary EVAR was abdominal aortic aneurysm, and in 1 patient, chronic abdominal aortic dissection. Five patients underwent secondary EVAR service interventions for endoleak treatment between the index EVAR and the final secondary surgical conversion. Thirteen patients underwent surgery in an elective setting and 3 patients underwent emergency surgery. The mean time from EVAR to open surgical conversion was 6.31 (SD 4.0) years (range 1.2\u201316.0\u2009years). The most common indication for conversion was endoleak formation (n\u2009=\u200912, 75%), followed by 3 cases of aortic rupture (1 patient with primary type 1 endoleak) and 2 cases of stent graft infection\u20141 with and 1 without an aortoduodenal fistula. One patient died during emergency open surgery of cardiopulmonary instability. Three patients developed postoperative renal dysfunction with recovery of their renal function before discharge. The in-hospital mortality rate was 12.5%. The median follow-up was 16.5\u2009months (interquartile range 21\u2009months). Freedom from death and aortic reintervention was 100%, respectively. After careful review of the index computed tomography scans for EVAR, the majority of failures could have been anticipated due to trade-offs with regard to length, diameter, morphology, shape and angulation of the proximal and\/or distal landing zone.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Despite being a challenging operation, late surgical conversion after EVAR yields excellent results with regard to outcome and freedom from the need for further aortic interventions. An anticipative strategy adhering to current recommendations for using or refraining from using EVAR in patients with anatomical challenges will help reduce the need for secondary surgical conversions and keep them to minimum.<\/jats:p><\/jats:sec>","DOI":"10.1093\/icvts\/ivz207","type":"journal-article","created":{"date-parts":[[2019,8,12]],"date-time":"2019-08-12T19:13:17Z","timestamp":1565637197000},"page":"944-949","source":"Crossref","is-referenced-by-count":9,"title":["Late surgical conversions after abdominal endovascular aortic repair: underlying mechanisms, clinical results and strategies for prevention"],"prefix":"10.1093","volume":"29","author":[{"given":"Andrzej","family":"Juraszek","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany"},{"name":"Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszy\u0144ski Institute of Cardiology, Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bartosz","family":"Rylski","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stoyan","family":"Kondov","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Scheumann","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3099-7254","authenticated-orcid":false,"given":"Maximilian","family":"Kreibich","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Morlock","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holger","family":"Schr\u00f6fel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Kari","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3305-9343","authenticated-orcid":false,"given":"Matthias","family":"Siepe","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Friedhelm","family":"Beyersdorf","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Czerny","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,8,29]]},"reference":[{"key":"2019112510403898800_ivz207-B1","first-page":"123","article-title":"[A self-fixing synthetic blood vessel endoprosthesis]","volume":"137","author":"Volodos","year":"1986","journal-title":"Vestn Khir Im I I Grek"},{"key":"2019112510403898800_ivz207-B2","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1097\/01.sla.0000234893.88045.dc","article-title":"Long-term outcomes after endovascular abdominal aortic aneurysm repair: the first decade","volume":"244","author":"Brewster","year":"2006","journal-title":"Ann Surg"},{"key":"2019112510403898800_ivz207-B3","doi-asserted-by":"crossref","first-page":"79.","DOI":"10.1007\/s11886-018-1023-6","article-title":"Percutaneous endovascular aortic aneurysm repair for abdominal aortic aneurysm","volume":"20","author":"Huff","year":"2018","journal-title":"Curr Cardiol Rep"},{"key":"2019112510403898800_ivz207-B4","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.jvs.2017.05.095","article-title":"Any nonadherence to instructions for use predicts graft-related adverse events in patients undergoing elective endovascular aneurysm repair","volume":"67","author":"Herman","year":"2018","journal-title":"J Vasc Surg"},{"key":"2019112510403898800_ivz207-B5","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.jvs.2006.01.010","article-title":"Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report","volume":"43","author":"Hobo","year":"2006","journal-title":"J Vasc Surg"},{"key":"2019112510403898800_ivz207-B6","doi-asserted-by":"crossref","first-page":"2848","DOI":"10.1161\/CIRCULATIONAHA.110.014902","article-title":"Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair","volume":"123","author":"Schanzer","year":"2011","journal-title":"Circulation"},{"key":"2019112510403898800_ivz207-B7","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.avsg.2017.03.168","article-title":"Reintervention rate after open surgery and endovascular repair for nonruptured abdominal aortic aneurysms","volume":"43","author":"Hwang","year":"2017","journal-title":"Ann Vasc Surg"},{"key":"2019112510403898800_ivz207-B8","doi-asserted-by":"crossref","first-page":"S138\u201356.","DOI":"10.21037\/cdt.2017.09.17","article-title":"Complications of endovascular aneurysm repair of the thoracic and abdominal aorta: evaluation and management","volume":"8","author":"Daye","year":"2018","journal-title":"Cardiovasc Diagn Ther"},{"key":"2019112510403898800_ivz207-B9","first-page":"S1","article-title":"Late surgical conversions after EVAR: underlying mechanisms, clinical results, and strategies for prevention","volume":"67","author":"Juraszek","year":"2019","journal-title":"Thorac Cardiovasc Surg"},{"key":"2019112510403898800_ivz207-B10","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1016\/j.jvs.2010.01.030","article-title":"Outcome of elective endovascular abdominal aortic aneurysm repair in octogenarians and nonagenarians","volume":"51","author":"Prenner","year":"2010","journal-title":"J Vasc Surg"},{"key":"2019112510403898800_ivz207-B11","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1016\/j.jvs.2014.01.005","article-title":"The impact of stent graft evolution on the results of endovascular abdominal aortic aneurysm repair","volume":"59","author":"Tadros","year":"2014","journal-title":"J Vasc Surg"},{"key":"2019112510403898800_ivz207-B12","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1016\/j.jvs.2018.02.041","article-title":"Abdominal aortic aneurysm neck remodeling after Anaconda stent graft implantation","volume":"68","author":"Vukovic","year":"2018","journal-title":"J Vasc Surg"},{"key":"2019112510403898800_ivz207-B13","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1016\/S0140-6736(16)31135-7","article-title":"Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial","volume":"388","author":"Patel","year":"2016","journal-title":"Lancet"},{"key":"2019112510403898800_ivz207-B14","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.ejvs.2017.03.002","article-title":"Open conversion after endovascular abdominal aneurysm repair: an 8 year single centre experience","volume":"53","author":"Ben Abdallah","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2019112510403898800_ivz207-B15","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jvs.2013.07.106","article-title":"Late open conversion after failed endovascular aortic aneurysm repair","volume":"59","author":"Klonaris","year":"2014","journal-title":"J Vasc Surg"},{"key":"2019112510403898800_ivz207-B16","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1016\/j.athoracsur.2010.12.033","article-title":"Mechanisms of failure and outcome of secondary surgical interventions after thoracic endovascular aortic repair (TEVAR)","volume":"91","author":"Dumfarth","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2019112510403898800_ivz207-B17","first-page":"816","article-title":"Fenestrated and branched aortic grafts","volume":"112","author":"Rylski","year":"2015","journal-title":"Dtsch Arztebl Int"},{"key":"2019112510403898800_ivz207-B18","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1583\/12-3845R.1","article-title":"Early histological changes in the porcine aortic media after thoracic stent-graft implantation","volume":"19","author":"Scheumann","year":"2012","journal-title":"J Endovasc Ther"},{"key":"2019112510403898800_ivz207-B19","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1016\/j.athoracsur.2011.06.073","article-title":"Self-made pericardial tube graft: a new surgical concept for treatment of graft infections after thoracic and abdominal aortic procedures","volume":"92","author":"Czerny","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2019112510403898800_ivz207-B20","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.ejvs.2017.07.017","article-title":"Self made xeno-pericardial aortic tubes to treat native and aortic graft infections","volume":"54","author":"Weiss","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2019112510403898800_ivz207-B21","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.athoracsur.2018.03.012","article-title":"Surgical treatment of native and prosthetic aortic infection with xenopericardial tube grafts","volume":"106","author":"Kreibich","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"2019112510403898800_ivz207-B22","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.ejvs.2017.10.011","article-title":"Editor\u2019s choice\u2014late open surgical conversion after endovascular abdominal aortic aneurysm repair","volume":"55","author":"Kansal","year":"2018","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2019112510403898800_ivz207-B23","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.jvs.2018.04.055","article-title":"Late open conversions after endovascular abdominal aneurysm repair in an urgent setting","volume":"69","author":"Perini","year":"2019","journal-title":"J Vasc Surg"},{"key":"2019112510403898800_ivz207-B24","doi-asserted-by":"crossref","first-page":"73","DOI":"10.23736\/S0021-9509.18.10173-X","article-title":"Late open conversion after endovascular abdominal aortic repair: a 20-year experience","volume":"60","author":"Joo","year":"2019","journal-title":"J Cardiovasc Surg"},{"key":"2019112510403898800_ivz207-B25","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1016\/j.jvs.2018.09.049","article-title":"Increasing use of open conversion for late complications after endovascular aortic aneurysm repair","volume":"69","author":"Mohapatra","year":"2019","journal-title":"J Vasc Surg"},{"key":"2019112510403898800_ivz207-B26","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.jvs.2018.03.426","article-title":"Strategies and outcomes for aortic endograft explantation","volume":"69","author":"Arnaoutakis","year":"2019","journal-title":"J Vasc Surg"},{"key":"2019112510403898800_ivz207-B27","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1016\/j.jvs.2015.02.019","article-title":"Late open conversion after endovascular abdominal aortic aneurysm repair","volume":"61","author":"Kouvelos","year":"2015","journal-title":"J Vasc Surg"}],"container-title":["Interactive CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/icvts\/article-pdf\/29\/6\/944\/31117745\/ivz207.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/icvts\/article-pdf\/29\/6\/944\/31117745\/ivz207.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,25]],"date-time":"2022-09-25T13:58:25Z","timestamp":1664114305000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/29\/6\/944\/5556408"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,29]]},"references-count":27,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,8,29]]},"published-print":{"date-parts":[[2019,12,1]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivz207","relation":{},"ISSN":["1569-9285"],"issn-type":[{"type":"electronic","value":"1569-9285"}],"subject":[],"published-other":{"date-parts":[[2019,12]]},"published":{"date-parts":[[2019,8,29]]}}}