@article{3147699,
    title = "Conversion to Open Repair After Endografting for Abdominal Aortic
Aneurysm: A Review of Causes, Incidence, Results, and Surgical
Techniques of Reconstruction",
    author = "Moulakakis, Konstantinos G. and Dalainas, Ilias and Mylonas, Spyridon and and Giannakopoulos, Triantafillos G. and Avgerinos, Efthimios D. and and Liapis, Christos D.",
    journal = "Journal of Endovascular Therapy",
    year = "2010",
    volume = "17",
    number = "6",
    pages = "694-702",
    publisher = "ALLIANCE COMMUNICATIONS GROUP DIVISION ALLEN PRESS",
    issn = "1526-6028, 1545-1550",
    doi = "10.1583/1545-1550-17.6.694",
    keywords = "endovascular aneurysm repair; abdominal aortic aneurysm; complications;
conversion; mortality",
    abstract = "Purpose: To review the incidence, causes, and mortality rates of early
and late conversion to open surgery after endovascular aneurysm repair
(EVAR) of abdominal aortic aneurysm (AAA).
Methods: A systematic search of the English-language literature from
2002 to 2009 was performed by interrogation of the PubMed, MEDLINE, and
EMBASE databases. Studies were included if they: (1) had >100 patients
treated with EVAR and (2) provided adequate data to calculate incidence
and associated mortality rates. The search yielded 13 articles with
sufficient data to analyze early conversion (12,236 patients, 178
conversions) and 15 articles with available data for late conversion
(14,298 patients, 279 conversions).
Results: The rate of early conversion among the 13 articles reviewed
ranged from 0.8% to 5.9%; more recent studies carried lower rates of
early conversion. Mortality rates of early conversion varied between 0%
and 28.5%. Overall, there were 178 (1.5%) early conversions among the
12,236 AAAs treated with EVAR, with an average mortality of 12.4%. The
rates of late conversion ranged from 0.4% to 22%. Of the 14,289 AAA
patients undergoing endovascular repair, 279 (1.9%) required late
conversion; the mortality rate was 10%.
Conclusion: Though the incidence is gradually declining, secondary
interventions persist as the Achilles’ heel of EVAR. A lifelong
follow-up strategy for AAA patients treated with EVAR is essential for
early detection and treatment of complications of the procedure.
Vascular surgeons should be familiar with the complex open conversion
procedures. J Endovasc Ther. 2010;17:694-702"
}