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• W3204369035 abstract "The widespread application of endovascular abdominal aortic aneurysm repair (EVAR) has ushered in an era of requisite postoperative surveillance and the risk of reintervention. However, the incidence of conversion of EVAR to open repair remains unknown. The purpose of the present analysis was to define the incidence of open conversion and the associated outcomes. The Society for Vascular Surgery Vascular Quality Initiative EVAR registry linked to Medicare claims was queried for open conversions from 2003 to 2016, providing a subsequent 5 years of follow-up for outcomes. The cumulative conversion incidence and outcomes after open intervention were delineated. Multivariable logistic regression was used to identify the independent predictors of conversion and mortality. Among 15,937 EVAR patients, 309 (1.9%) had required conversion: 132 (43%) early conversion (<30 days) and 177 (57%) late conversion (>30 days). The cumulative incidence of conversion was constant over time and by geographic region. The independent determinants of conversion included female sex (hazard ratio [HR], 1.49; P < .001), aneurysm diameter >6 cm at the index EVAR (HR, 1.74; P < .001), and aorto-uni-iliac repair (HR, 2.19; P < .001). Elective vs urgent or emergent EVAR was less likely to result in conversion (HR, 0.58; P < .001; Fig). Adjunctive measures such as endoanchors or cuff extensions (HR, 0.62; P = .06) were protective against long-term conversion. Both early (HR, 1.6; P < .001) and late (HR, 1.26; P = .07) conversions were associated with significant 30-day mortality (total cohort, 15%) and 1-year mortality (total cohort, 25%). The patients requiring conversion had high rates of 30-day readmission (42%) and cardiac (45%), pulmonary (30%), and renal (32%) complications (Table). Our analysis is among the first to document the incidence and outcomes for EVAR open conversion in a large national cohort with long-term follow-up. Female sex, large aneurysm size, complex anatomy, and urgent/emergent EVAR were predictive factors for an increased risk of open conversion. A greater proportion of conversions were performed in the early postoperative period despite perceptions that conversion is a delayed phenomenon. In all cases, conversion was associated with significant morbidity and mortality, highlighting the importance of appropriate patient selection.TableOutcomes of open conversion after EVAR (n = 309 conversions)OutcomeNo. (%)Mortality In-hospital36 (12) 30-Day45 (15) 90-Day58 (19) 1-Year77 (25)30-Day readmission131 (42)Discharge to home104 (34)Complications Cardiac138 (45) Pulmonary94 (30) Renal failure99 (32)EVAR, Endovascular abdominal aortic aneurysm repair. Open table in a new tab" @default.
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• W3204369035 date "2021-10-01" @default.
• W3204369035 modified "2023-09-23" @default.
• W3204369035 title "Contemporary Incidence, Outcomes, and Survival Associated With Endovascular Abdominal Aortic Aneurysm Repair Conversion to Open Repair" @default.
• W3204369035 doi "https://doi.org/10.1016/j.jvs.2021.07.069" @default.
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