A Retrospective Analysis of Late Open Conversions Following Failed Endovascular Aneurysm Repair.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-10-10 eCollection Date: 2024-10-01 DOI:10.31083/j.rcm2510363

Bahadır Aytekin, Bekir Boğaçhan Akkaya, Hayrettin Levent Mavioğlu, Hakkı Zafer İşcan

{"title":"A Retrospective Analysis of Late Open Conversions Following Failed Endovascular Aneurysm Repair.","authors":"Bahadır Aytekin, Bekir Boğaçhan Akkaya, Hayrettin Levent Mavioğlu, Hakkı Zafer İşcan","doi":"10.31083/j.rcm2510363","DOIUrl":null,"url":null,"abstract":"Background: The incidence of late open surgical conversions (OSCs) has recently increased. Vascular surgeons face additional technical challenges in late conversion surgery of failed endovascular aneurysm repair (EVAR) due to the presence of a previously deployed endograft. Based on our institutional experience, this study aimed to delineate methods to improve late open conversion outcomes, proposing solutions for technical challenges.Methods: All preoperative OSC data on failed EVARs operated in our Cardiovascular Surgery Clinic between January 2017 and January 2024 were evaluated retrospectively. Study endpoints included early (30-day or in-hospital) and late follow-up outcomes. Early outcomes included perioperative mortality and morbidities, intensive care unit (ICU) period, and length of hospital stay (LOS). The main outcome of interest during follow-up was overall survival.Results: Sixteen patients in our hospital, comprising eight elective and eight emergency procedures, underwent OSCs following EVAR. The difference between the 30-day mortality rates for the elective and urgent late conversions was significant (p < 0.001). Of these patients, 15 were male, with a mean age of 70.8 years (range: 62-80). Preoperative cardiac shock status and low hematocrit level (<20%) were independent mortality factors (p < 0.001). The ICU period was 8.7 ± 5.3 days (2-20 days) on average, and LOS was 17.3 ± 8.4 (6-29 days) days on average. The mean time to open surgical conversion in this cohort was 44.4 ± 16.8 months. The 5-year overall survival rate was 43.75%.Conclusions: The incidence of open surgical conversion is notably growing. Emergent open surgical conversions exhibit poorer mortality outcomes compared to elective procedures. Further data are essential to evaluate the ramifications of expanding the use of EVAR beyond the instructions for use (IFU) guidelines. The procedures involving patients who challenge the IFU criteria should be conducted at experienced centers and require close monitoring. Open surgical repair (OSR) as the initial treatment opportunity could be an alternative strategy for improving outcomes in this patient cohort.","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522759/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.31083/j.rcm2510363","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The incidence of late open surgical conversions (OSCs) has recently increased. Vascular surgeons face additional technical challenges in late conversion surgery of failed endovascular aneurysm repair (EVAR) due to the presence of a previously deployed endograft. Based on our institutional experience, this study aimed to delineate methods to improve late open conversion outcomes, proposing solutions for technical challenges.

Methods: All preoperative OSC data on failed EVARs operated in our Cardiovascular Surgery Clinic between January 2017 and January 2024 were evaluated retrospectively. Study endpoints included early (30-day or in-hospital) and late follow-up outcomes. Early outcomes included perioperative mortality and morbidities, intensive care unit (ICU) period, and length of hospital stay (LOS). The main outcome of interest during follow-up was overall survival.

Results: Sixteen patients in our hospital, comprising eight elective and eight emergency procedures, underwent OSCs following EVAR. The difference between the 30-day mortality rates for the elective and urgent late conversions was significant (p < 0.001). Of these patients, 15 were male, with a mean age of 70.8 years (range: 62-80). Preoperative cardiac shock status and low hematocrit level (<20%) were independent mortality factors (p < 0.001). The ICU period was 8.7 ± 5.3 days (2-20 days) on average, and LOS was 17.3 ± 8.4 (6-29 days) days on average. The mean time to open surgical conversion in this cohort was 44.4 ± 16.8 months. The 5-year overall survival rate was 43.75%.

Conclusions: The incidence of open surgical conversion is notably growing. Emergent open surgical conversions exhibit poorer mortality outcomes compared to elective procedures. Further data are essential to evaluate the ramifications of expanding the use of EVAR beyond the instructions for use (IFU) guidelines. The procedures involving patients who challenge the IFU criteria should be conducted at experienced centers and require close monitoring. Open surgical repair (OSR) as the initial treatment opportunity could be an alternative strategy for improving outcomes in this patient cohort.

查看原文本刊更多论文

血管内动脉瘤修补失败后晚期开放手术转归的回顾性分析。

背景：晚期开放手术转换（OSC）的发生率近来有所上升。血管外科医生在血管内动脉瘤修补术（EVAR）失败的晚期转换手术中面临更多的技术挑战，原因是存在先前部署的内移植物。根据我们的机构经验，本研究旨在阐明改善晚期开放转换结果的方法，并提出应对技术挑战的解决方案：回顾性评估了2017年1月至2024年1月期间在我院心血管外科门诊手术失败的EVAR的所有术前OSC数据。研究终点包括早期（30 天或院内）和晚期随访结果。早期结果包括围手术期死亡率和发病率、重症监护室（ICU）时间和住院时间（LOS）。随访期间的主要结果是总生存率：我院有16名患者在EVAR术后接受了OSC手术，其中包括8例择期手术和8例急诊手术。择期手术和急诊晚期手术的 30 天死亡率差异显著（P < 0.001）。这些患者中有 15 名男性，平均年龄为 70.8 岁（范围：62-80 岁）。术前心脏休克状态和低血细胞比容水平（P < 0.001）。重症监护室时间平均为 8.7 ± 5.3 天（2-20 天），LOS 平均为 17.3 ± 8.4 天（6-29 天）。该组患者转为开放手术的平均时间为（44.4 ± 16.8）个月。5年总生存率为43.75%：结论：开腹手术转换的发生率明显增加。结论：开腹手术转换的发生率显著增加，与选择性手术相比，紧急开腹手术转换的死亡率较低。要评估在使用说明（IFU）指南之外扩大 EVAR 使用范围的影响，必须获得更多数据。涉及挑战 IFU 标准的患者的手术应在经验丰富的中心进行，并需要密切监测。将开放手术修复（OSR）作为初始治疗机会可能是改善这类患者预后的另一种策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.