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      Late open conversion after endovascular repair of abdominal aneurysm failure: Better and easier option than complex endovascular treatment

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          Conversion to open repair becomes the last option in case of endovascular repair of abdominal aneurysm failure, when radiological interventional procedures are unfeasible. While early conversion to open repair generally derives from technical errors, aetiopathogenesis and results of late conversion to open repair often remain unclear.


          We report data from our Institute’s experience on late conversion to open repair. Twenty-two late conversion to open repairs out of 435 consecutive patients treated during a 18 years period, plus two endovascular repair of abdominal aneurysms performed in other centres, are analysed. The indication for conversion to open repair was aneurysm enlargement because of type I, type III, type II endoleak and endotension. Even if seven cases (23%) had shown an initial aneurysmal shrinkage, in a later phase, the sac began to enlarge again. In 12 patients, conversion to open repair was the last chance after unsuccessful secondary endovascular procedures.


          Three cases (12.5%) were treated in emergency. Aortic cross-clamping was only infrarenal in 10 cases, only or temporarily suprarenal in 14 and temporarily supraceliac in 9 cases, for 19 total and 5 partial endograft excisions. Two patients died for Multiple Organ Failure (MOF), on 42nd (endovascular repair of abdominal aneurysm infection) and 66th postoperative day. No other conversion to open repair-related deaths or major complications were revealed by follow-up post-conversion to open repair (mean: 68 months ranging from 24 to 180 months).


          Late conversion to open repair is often an unpredictable event. It represents a technical challenge: specifically, the most critical point is the proximal aortic clamping that often temporarily excludes the renal circulation. In our series, conversion to open repair can be performed with a low rate of complications. In response to an endovascular repair of abdominal aneurysm failure, before applying complex procedures of endovascular treatment, conversion to open repair should be taken into account.

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          Most cited references 25

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          Long-term outcome of open or endovascular repair of abdominal aortic aneurysm.

          For patients with large abdominal aortic aneurysms, randomized trials have shown an initial overall survival benefit for elective endovascular repair over conventional open repair. This survival difference, however, was no longer significant in the second year after the procedure. Information regarding the comparative outcome more than 2 years after surgery is important for clinical decision making. We conducted a long-term, multicenter, randomized, controlled trial comparing open repair with endovascular repair in 351 patients with an abdominal aortic aneurysm of at least 5 cm in diameter who were considered suitable candidates for both techniques. The primary outcomes were rates of death from any cause and reintervention. Survival was calculated with the use of Kaplan-Meier methods on an intention-to-treat basis. We randomly assigned 178 patients to undergo open repair and 173 to undergo endovascular repair. Six years after randomization, the cumulative survival rates were 69.9% for open repair and 68.9% for endovascular repair (difference, 1.0 percentage point; 95% confidence interval [CI], -8.8 to 10.8; P=0.97). The cumulative rates of freedom from secondary interventions were 81.9% for open repair and 70.4% for endovascular repair (difference, 11.5 percentage points; 95% CI, 2.0 to 21.0; P=0.03). Six years after randomization, endovascular and open repair of abdominal aortic aneurysm resulted in similar rates of survival. The rate of secondary interventions was significantly higher for endovascular repair. ( number, NCT00421330.) 2010 Massachusetts Medical Society
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            SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary.

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              Defining acute renal failure: the RIFLE criteria.

              Acute renal failure is common among critically ill patients and carries significant morbidity and mortality. The reported incidence and the attributed morbidity and mortality of acute renal failure vary widely, largely owing to the use of a wide variety of definitions for acute renal failure. Until recently, no consensus existed about how to best define, characterize, and study acute renal failure. This lack of a standard definition has been a major impediment to the progress of clinical and basic research in this field. This review outlines some of the physiologic principles that may help us better understand and define acute renal failure and describes the RIFLE criteria (an acronym comprising Risk, Injury, and Failure; and Loss, and End-stage kidney disease), a recent consensus method of defining and stratifying acute renal failure. Also discussed are many of the challenges and controversies associated with achieving consensus and developing a classification for acute renal dysfunction.

                Author and article information

                JRSM Cardiovasc Dis
                JRSM Cardiovasc Dis
                JRSM Cardiovascular Disease
                SAGE Publications (Sage UK: London, England )
                14 March 2018
                Jan-Dec 2018
                : 7
                Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
                Author notes
                Edoardo Cervi, Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia BS, Italy. Email: edoardo.cervi@
                © The Author(s) 2018

                Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (

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                January-December 2018


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