Secondary conversion of the Gore Excluder to operative abdominal aortic aneurysm repair

被引:38
作者
Kong, LS [1 ]
MacMillan, D [1 ]
Kasirajan, K [1 ]
Milner, R [1 ]
Dodson, TF [1 ]
Salam, AA [1 ]
Smith, RB [1 ]
Chaikof, EL [1 ]
机构
[1] Emory Univ, Sch Med, Dept Surg, Div Vasc Surg & Endovasc Therapy, Atlanta, GA 30322 USA
关键词
D O I
10.1016/j.jvs.2005.05.056
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: Reports continue to document the occurrence of major adverse events after endovascular aortic aneurysm repair. Although many of these problems can be successfully managed through endovascular salvage, operative conversion with explantation of the endoprosthesis remains necessary in some patients. We report herein a review of all patients initially enrolled in multicenter US clinical trials of the Excluder endograft who underwent secondary conversion to open surgical repair. Methods. Clinical data and relevant medical records of patients enrolled in phase I and II multicenter US clinical trials of the Excluder endograft were retrospectively reviewed for adverse events and further narrowed to those patients who underwent secondary operative conversion. Hospital records, operative and anesthesia reports, and all imaging studies were analyzed at initial implantation and at the time of subsequent open surgical repair. Results. Late open conversion was performed in 16 (2.7%) of the 594 patients enrolled in the Excluder clinical trials. Presumed endotension accounted for 8 of 16 of secondary conversions. In two of these patients, however, an endoleak was identified at the time of open surgical repair. Of the remaining eight patients, two underwent conversion for device infection, five for persistent endoleak, and one for aneurysm rupture. The overall 30-day mortality was 6.25% (1/16), with one death occurring in a patient with a ruptured aneurysm. Of patients who underwent conversion because of endotension, the maximal abdominal aortic aneurysm diameter (mean +/- SD) at the time of initial implantation and subsequent graft removal was 61 +/- 11 turn and 70 10 mm, respectively. The mean time to open conversion for treatment of endotension was 37 +/- 12 months (range, 20-50 months; median, 42 months). Freedom from conversion was 98.6% and 96.7% at 24 and 48 months, respectively. Conclusions: Endotension in the absence of a demonstrable endoleak has been a major indication for late surgical conversion in patients treated with the Excluder endograft. Given the potential presence of an undetected endoleak and the possible effects of progressive sac enlargement on long-term device stability, continued close surveillance of patients with assumed endotension is required. Should changes in device design eliminate endotension, a further reduction in the already low incidence of late open conversion of the Excluder endograft can be anticipated.
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页码:631 / 638
页数:8
相关论文
共 32 条
[1]  
Arko FR, 2002, J ENDOVASC THER, V9, P711, DOI 10.1583/1545-1550(2002)009<0711:ERREAL>2.0.CO
[2]  
2
[3]   Mid-term results of endovascular versus open repair for abdominal aortic aneurysm in patients anatomically suitable for endovascular repair [J].
Becquemin, JP ;
Bourriez, A ;
D'Audiffret, A ;
Zubilewicz, T ;
Kobeiter, H ;
Allaire, E ;
Mellière, D ;
Desgranges, P .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2000, 19 (06) :656-661
[4]   Ruptured abdominal aortic aneurysm after endovascular repair [J].
Bernhard, VM ;
Mitchell, RS ;
Matsumura, JS ;
Brewster, DC ;
Decker, M ;
Lamparello, P ;
Raithel, D ;
Collin, J .
JOURNAL OF VASCULAR SURGERY, 2002, 35 (06) :1155-1162
[5]   Late abdominal aortic aneurysm enlargement after endovascular repair with the excluder device [J].
Cho, JS ;
Dillavou, ED ;
Rhee, RY ;
Makaroun, AS .
JOURNAL OF VASCULAR SURGERY, 2004, 39 (06) :1236-1241
[6]   Clinical failures of endovascular abdominal aortic aneurysm repair: Incidence, causes, and management [J].
Dattilo, JB ;
Brewster, DC ;
Fan, CM ;
Geller, SC ;
Cambria, RP ;
LaMuraglia, GM ;
Greenfield, AJ ;
Lauterbach, SR ;
Abbott, WM .
JOURNAL OF VASCULAR SURGERY, 2002, 35 (06) :1137-1144
[7]   An update of the Zenith endovascular graft for abdominal aortic aneurysms: Initial implantation and mid-term follow-up data [J].
Greenberg, RK ;
Lawrence-Brown, M ;
Bhandari, G ;
Hartley, D ;
Stelter, W ;
Umscheid, T ;
Chuter, T ;
Ivancev, K ;
Green, R ;
Hopkinson, B ;
Semmens, J ;
Ouriel, K .
JOURNAL OF VASCULAR SURGERY, 2001, 33 (02) :S157-S164
[8]   Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial [J].
Greenhalgh, RM ;
Brown, LC ;
Kwong, GPS ;
Powell, JT ;
Thompson, SG .
LANCET, 2004, 364 (9437) :843-848
[9]  
Harris Peter L, 2004, Vascular, V12, P33
[10]   Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: The EUROSTAR experience [J].
Harris, PL ;
Vallabhaneni, SR ;
Desgranges, P ;
Bacquemin, JP ;
van Marrewijk, C ;
Laheij, RJF .
JOURNAL OF VASCULAR SURGERY, 2000, 32 (04) :739-749