PMID- 32599108 OWN - NLM STAT- MEDLINE DCOM- 20210118 LR - 20210118 IS - 1615-5947 (Electronic) IS - 0890-5096 (Linking) VI - 70 DP - 2021 Jan TI - Surgical "New Aortic Carrefour Technique" for Late Open Conversion After Endovascular Aortic Repair. PG - 434-443 LID - S0890-5096(20)30528-8 [pii] LID - 10.1016/j.avsg.2020.06.027 [doi] AB - BACKGROUND: The aim of the study is to report the early and midterm outcomes of late open conversion (LOC) after endovascular aortic repair (EVAR) using the "new aortic carrefour technique" (NACT) for preservation of the stent-graft iliac limbs. Late conversions were defined as explants >6 months after previous EVAR. METHODS: Patients treated for elective or urgent LOC after EVAR with the NACT at a single center (2009-2019), and with >/=6 months of follow-up, were included. Briefly, after completing the proximal aortic anastomosis, the endograft iliac limbs were truncated and sutured together to create a "new aortic carrefour" (Veraldi's technique). A Dacron-knitted straight graft was therefore sutured to the newly created aortic bifurcation. Outcomes of interest were as follows: immediate technical success, intraoperative characteristics, and reinterventions. Results are reported as the number (and percentages) or median (and interquartile range [IQR]). RESULTS: During the study period, 433 patients underwent standard EVAR for abdominal aortic aneurysm and 20 underwent LOC. Of these, 9 consecutive patients were deemed suitable and treated with NACT. The indication for conversion was endoleak in 6 (type IA n = 1, type II n = 4, type III n = 1), complete graft thrombosis (n = 2), and one case of sac enlargement without any clear signs of endoleak at computed tomography angiography. Of these cases, six were treated electively, while three were treated in urgent setting including one case of rupture. The median procedure, aortic cross-clamping, and distal anastomosis times were 280 minutes (IQR: 225-290), 24 minutes (IQR: 22-29), and 15 minutes (IQR: 14-18), respectively. The median blood loss was 1,600 mL (IQR: 700-1,900), and the median hospital stay was 8 days (IQR 7-12). None of the patients died and neither required unplanned reintervention within 30 days. At a median imaging follow-up of 13 months (IQR 8-43), there were no reinterventions due to residual leaks or technical defects. One patient died during follow-up, and the recorded cause of death was heart failure. CONCLUSIONS: The use of the NACT with preservation of the original endograft iliac limbs for LOC after EVAR is a safe and feasible technique, which results in a low perioperative morbidity and mortality rate in selected patients. The technique is effective during midterm follow-up and might represent a valuable tool to expand the armamentarium of vascular surgeons for surgical regrafting after EVAR. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Veraldi, Gian Franco AU - Veraldi GF AD - Department of Vascular Surgery, University and Hospital Trust of Verona, University of Verona-School of Medicine, Verona, Italy. FAU - Mastrorilli, Davide AU - Mastrorilli D AD - Department of Vascular Surgery, University and Hospital Trust of Verona, University of Verona-School of Medicine, Verona, Italy. Electronic address: davide.mastrorilli87@gmail.com. FAU - Bonvini, Stefano AU - Bonvini S AD - Department of Vascular Surgery, Santa Chiara Hospital, Trento, Italy. FAU - D'Oria, Mario AU - D'Oria M AD - Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy. FAU - Lepidi, Sandro AU - Lepidi S AD - Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy. FAU - Mezzetto, Luca AU - Mezzetto L AD - Department of Vascular Surgery, University and Hospital Trust of Verona, University of Verona-School of Medicine, Verona, Italy. LA - eng PT - Journal Article PT - Video-Audio Media DEP - 20200626 PL - Netherlands TA - Ann Vasc Surg JT - Annals of vascular surgery JID - 8703941 SB - IM MH - Aged, 80 and over MH - Aortic Aneurysm, Abdominal/diagnostic imaging/*surgery MH - Aortic Rupture/diagnostic imaging/etiology/*surgery MH - Blood Vessel Prosthesis MH - *Blood Vessel Prosthesis Implantation/adverse effects/instrumentation MH - *Conversion to Open Surgery/adverse effects MH - Endoleak/diagnostic imaging/etiology/*surgery MH - *Endovascular Procedures/adverse effects/instrumentation MH - Graft Occlusion, Vascular/diagnostic imaging/etiology/*surgery MH - Humans MH - Male MH - Reoperation MH - Retrospective Studies MH - Risk Factors MH - Stents MH - Thrombosis/diagnostic imaging/etiology/*surgery MH - Time Factors MH - Treatment Outcome EDAT- 2020/07/01 06:00 MHDA- 2021/01/20 06:00 CRDT- 2020/06/30 06:00 PHST- 2020/05/16 00:00 [received] PHST- 2020/06/11 00:00 [revised] PHST- 2020/06/12 00:00 [accepted] PHST- 2020/07/01 06:00 [pubmed] PHST- 2021/01/20 06:00 [medline] PHST- 2020/06/30 06:00 [entrez] AID - S0890-5096(20)30528-8 [pii] AID - 10.1016/j.avsg.2020.06.027 [doi] PST - ppublish SO - Ann Vasc Surg. 2021 Jan;70:434-443. doi: 10.1016/j.avsg.2020.06.027. Epub 2020 Jun 26.