Infrarenal Clamping in Late Open Conversions After Endovascular Abdominal Aneurysm Repair: A 28-Year Single-Center Experience

Abstract

Background: The present study aimed to report the technical aspects and outcomes of late open conversion (LOC) after endovascular aneurysm repair (EVAR) performed in a single-center exclusively with infrarenal clamping.

Methods: This prospective single-center study analyzed the cases of LOC (>30 days) performed in our center from January 1996 to August 2024. The primary endpoints were technical success, 30-day mortality, and morbidity.

Results: During the analysis period, 37 patients underwent LOC with infrarenal clamping. The mean age at conversion was 75.59 ± 6.28 years. The endografts were explanted after a mean of 45.39 ± 30.27 months. The indications for LOC were: endoleak in 32 cases (17 type I, four type II, four type III, four endotension, and three cases with multiple endoleaks), two distal migrations of the endograft, two graft infections, and one endograft thrombosis. Partial conversion was performed in 72.9% (27/37) of cases. A partial proximal explant was performed in 63% of cases (17/27). The technical success was 100% (37/37). Overall 30-day mortality was 10.8%. The 30-day mortality was 7.41% (2/27) in elective patients and 20% (2/10) in the urgent setting (P = 0.29). Postoperative acute kidney damage (AKD) requiring transient hemodialysis rate was 9.1%. The mean follow-up was 42.35 ± 50.47 months. The estimated 5-year survival rate was 69%. No aneurysm-related death occurred during follow-up.

Conclusion: Infrarenal clamping during LOC is feasible. This technique, associated with partial endograft explantation, may allow the surgical procedure in selected cases and may potentially reduce postoperative renal complications related to suprarenal clamping.