The safety of EVAS surgical conversion in a comparative monocentric analysis.

OBJECTIVES: Endovascular aneurysm sealing (EVAS) was a widespread technology to treat abdominal aortic aneurysm (AAA). However, the particular morphology and structure of this Endoprosthesis predisposed to proximal sealing defects with a high rate of re-intervention or conversion to open surgery treatments. The purpose of this article is to report our experience on late open conversion of Nellix device, compared to previous reported experience.

MATERIALS AND METHODS: Between September 2013 and February 2020, 8 late open surgical conversions for endoleak were performed in our center: four of these were for EVAR. Four of these were EVAS devices required explantation and were included in the study. All excisions of infected abdominal aortic endo-graft were excluded.

RESULTS: All patients were treated within the original instructions for use (IFU). Aorto-bi-iliac reconstruction was performed with a bifurcated Dacron graft in all 4 cases. At 12 months Doppler ultrasonography (DUS) follow-up good results at short term with preserved primary patency and freedom of re-intervention in three cases were reported . Only one patient died 16 days after the procedure. Nevertheless the endo-prosthetic structure allows in three of our cases to clamp down the renal level, with a decrease of the time of lower limbs ischemia and greater safety of the open surgery repair procedure.

CONCLUSION: The EVAS conversion is common and a closer follow up is required. The most recurrent open surgery indication is the its migration and the Endoleak type 1. The procedure is influenced by multiple comorbidities; emergency graft excision appears to increase morbidity and mortality, compared to elective surgical setting.