Delayed open conversion after endovascular aortic repair

Open Repair of a Large Abdominal Aortic Aneurysm With a Type 2 Endoleak After an Endovascular Aortic Aneurysm Repair: A Case Report and Literature Review

A type 2 endoleak (T2E) can occur after an endovascular aortic aneurysm repair (EVAR). The repair of a T2E is recommended after a sac enlargement of ≥5mm. We present a unique case of a 10 cm aneurysm sac that underwent open explantation 11 years after the initial EVAR and after having undergone several interventions to address the T2E.

Open vs. endovascular thoracoabdominal aortic aneurysm repair: tale of the tape

Open surgical repair persists as the gold-standard operation for thoracoabdominal aortic aneurysm; however, endovascular repair has become commonplace. Technical considerations in thoracoabdominal aortic aneurysm treatment are particularly complex, insofar as it involves critical branching arteries feeding the visceral organs. Newer, low-profile devices make total endovascular thoracoabdominal aortic aneurysm repair more feasible and, thus, appealing. For younger and low-risk patients, the choice between open and endovascular therapy remains controversial. Despite the advantages of a minimally invasive procedure, data suggest that endovascular aortic repair incurs a greater risk of spinal cord deficit, and the durability of endovascular aortic repair remains unclear. It is difficult to compare outcomes between endovascular and open thoracoabdominal aortic aneurysm repair, primarily because of the current investigational status of endovascular devices, the variety of approaches to endovascular repair, differing patient populations, lack of prospective randomized studies, and minimal medium- and long-tern follow-up data on endovascular repair. When deciding between open and endovascular approaches, one should consider which is more suitable for each patient. Older patients generally benefit from a less invasive approach. Open repair should be considered for young patients and those with heritable thoracic aortic disease. Infection and fistulae are best treated by open repair, although endovascular intervention as a lifesaving bridge to definitive repair has evolved to become a critical component of initial treatment. It is crucial to have technical expertise in both open and endovascular procedures to provide the best aortic repair for the patient. This may require dedicated aortic programs at tertiary institutions.