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.
