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Late Explantation of Aortic Endografts: A Two Decade Experience
David J. Laczynski, MD, Vishnu Yanamaladoddi, MD, Sean P. Lyden, MD, Jon G. Quatromoni, MD, Levester Kirksey, MD, Ali Khalifeh, MD, Ravi N. Ambani, MD, Francis J. Caputo, MD.
Cleveland Clinic, Cleveland, OH, USA.

Late explantation of aortic endografts: A Two Decade ExperienceLaczynski DJ, Yanamaladoddi V, Lyden SP, Quatromoni JG, Kirksey L, Khalifeh A, Ambani RN, Caputo FJ
OBJECTIVE: With a quarter century of endovascular aneurysm repair (EVAR) the number of patients requiring explantation and open aneurysm repair has steadily increased. We review and update a single-center experience with EVAR explants to identify pre-operative indications and presentation, evolution of technique, operative outcomes to discern factors that may alter management of this difficult pathology. METHODS: A retrospective analysis of EVAR requiring late explants, >1 month after implant, was performed. Patient demographics, type of graft, duration of implant, reason for removal, operative technique, length of stay, complications, and in-hospital and late mortality were reviewed. Two time periods were analyzed together and separately, our original series of 100 patients from 1999-2012 and from 2013-2022.RESULTS: During 1999 to 2022, 261 patients (87% male) required EVAR explant. The average age was 74. The median length of time since implantation was 48 months. The second decade experience had a significantly longer implantation time of 61 months compared with the first decade of 41 months (p <0.001). Overall 30-day mortality was 8.4%. There was a significant decrease in overall 30-day mortality from the first to second decade (14% vs 5%, p = 0.009). The most common indication for explant was type I endoleak which was present in 50% of cases overall and in 57% of cases in the most recent decade. There was a significant increase in partial explant of the EVAR graft from the first to second decade. CONCLUSIONS: With over 2 decades of experience, our institution has seen a steady increase in patients requiring explantation of EVAR devices. Type I endoleak remains the most common indication for explant. Overall mortality significantly decreased over time. Our operative technique has evolved to more frequently doing partial explantation of the endograft.


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