Multicenter Comparative Analysis of Late Open Conversion in Patients With Adherence and Nonadherence to Instructions for Use Endovascular Aneurysm Repair
Por:
Lopez-Espada C, Linares-Palomino J, Guerra Requena M, Serrano Hernando FJ, Iborra Ortega E, Fernández-Samos R, Zanabili Al-Sibbai A, González Cañas E, Rodriguez Sánchez JM, Zaragozá García JM, García León A, Manzano Grossi S, de Benito L, Gil Sala D and Revuelta Mariño L
Publicada:
1 dic 2023
Ahead of Print:
1 jun 2022
Resumen:
Purpose: The widespread adoption of endovascular aneurysm repair (EVAR) as preferred treatment modality for abdominal aortic aneurysm (AAA) has enlarged the number of patients needing open surgical conversion (OSC). The relationship between adherence to Instructions For Use (IFU) and EVAR long-term outcomes remains controversial. The aim of this study is to compare preoperative differences and postoperative outcomes between EVAR patients not adjusted to IFU and adjusted to IFU who underwent OSC. Methods: This multicenter retrospective study reviewed 33 explanted EVARs between January 2003 and December 2019 at 14 Vascular Units. Patients were included if OSC occurred >30 days after implantation and excluded if explantation was performed to treat an endograft infection, aortic dissection, or traumatic transections. Variables analyzed included baseline characteristics, adherence to IFU, implant and explant procedural details, secondary reinterventions, and postoperative outcomes. Results: Fifteen explanted patients (15/33, 45.5%) were identified not accomplished to IFU (out-IFU) at initial EVAR vs 18 explanted patients adjusted (in-IFU). During follow-up, a mean of 1.73 +/- 1.2 secondary reinterventions were performed, with more type I endoleaks treated in the subgroup out-IFU: 16.7% vs 6.3% in-IFU patients and more type III endoleaks (8.3% vs 0%). Patients out-IFU had shorter mean interval from implant to explant: 47.60 +/- 28.8 months vs 71.17 +/- 48. Type II endoleak was the most frequent indication for explantation. Low-flow endoleaks (types II, IV, V) account for 44% of indications for OSC in subgroup of patients in-IFU, compared with 13.3% in patients out-IFU and high-flow endoleaks (types I and III) were the main indication for patients out-IFU (33.3% vs 16.7% in-IFU). Total endograft explantation was performed in 57.5% of cases (19/33) and more suprarenal clamping was required in the subgroup out-IFU. Overall, 30-day mortality rate was 12.1% (4/33): 20% for patients out-IFU and 5.6% in-IFU. Conclusions: In our experience, type II endoleak is the most common indication for conversion and differences have been found between patients treated outside IFU with explantation taking place earlier during follow-up, mainly due to high-flow endoleaks and with higher mortality in comparison with patients adjusted to IFU. Ongoing research is required to delve into these differences.
Filiaciones:
Lopez-Espada C:
Vascular Surgery Unit, University Hospital Virgen de las Nieves, Granada, Spain
Linares-Palomino J:
Vascular Surgery Unit, University Hospital Virgen de las Nieves, Granada, Spain
Department of Surgery, University of Granada, Granada, Spain
Guerra Requena M:
Vascular Surgery Unit, University Hospital Guadalajara, Guadalajara, Spain
Serrano Hernando FJ:
Vascular Surgery Unit, University Hospital Clinico San Carlos, Madrid, Spain
Iborra Ortega E:
Vascular Surgery Unit, University Hospital Bellvitge, Barcelona, Spain
Fernández-Samos R:
Vascular Surgery Unit, University Hospital de Leon, León, Spain
Zanabili Al-Sibbai A:
Vascular Surgery Unit, Univesity Hospital Central de Asturias, Oviedo, Spain
González Cañas E:
Vascular Surgery Unit, Corporació Sanitaria Parc Tauli de Sabadell, Sabadell, Spain
Rodriguez Sánchez JM:
Vascular Surgery Unit, University Hospital Virgen del Rocio, Sevilla, Spain
:
Vascular Surgery Unit, University Hospital Dr. Peset, Valencia, Spain
García León A:
Vascular Surgery Unit, University Hospital Virgen de Valme, Sevilla, Spain
Manzano Grossi S:
Vascular Surgery Unit, University Hospital Gregorio Marañón, Madrid, Spain
de Benito L:
Vascular Surgery Unit, University Hospital Fundación Alcorcón, Madrid, Spain
Gil Sala D:
Vascular Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
Revuelta Mariño L:
Vascular Surgery Unit, University Hospital de Alava, Vitoria-Gasteiz, Spain
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