Open Surgical Conversion After Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

Abstract

Endovascular aneurysm repair (EVAR) is a preferred treatment for abdominal aortic aneurysms, though it comes with complications such as endoleaks and graft infections that may necessitate late open conversion (LOC). This systematic review and meta-analysis, drawing on studies from PubMed/MEDLINE, Embase, and the Cochrane Database of Systematic Reviews, aimed to evaluate the incidence, outcomes, and factors leading to LOC after EVAR. The analysis of 11 selected studies revealed a 5.3% incidence of LOC, with a patient cohort predominantly male (79%) and an average age of 73.5 years. The interval between initial EVAR and LOC was 35.1 months on average, with the Excluder device most frequently necessitating LOC. A notable 68% of endovascular salvage attempts before LOC failed. The study highlighted rupture and type I endoleak as the primary reasons for urgent LOC, which exhibited a 10-fold higher mortality rate compared to elective LOC. Elective LOC procedures had a 30-day mortality rate similar to primary elective open aneurysm repairs. These findings underscore the importance of vigilant post-EVAR patient monitoring and suggest that the methodological quality of underlying research should be considered in interpreting these results.

Keywords: abdominal aortic aneurysm; elective conversion; emergency conversion; endovascular aneurysm repair; late open conversion; mortality.

Figure 1. PRISMA 2020 flow diagram

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Figure 2. Forest plot illustrating the outcomes in the studies included in the meta-analysis

The studies included in this analysis are as follows: Ben Abdallah et al. [4], Arya et al. [5], Brinster et al. [6], Chaar et al. [7], Ferrero et al. [8], Joo et al. [9], Klonaris et al. [10], Kansal et al. [11], Bonardelli et al. [12], Perini et al. [13], Turney et al. [14]