ISMICS - Fast Track Surgery For Open Conversion After Failed Evar

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Fast Track Surgery For Open Conversion After Failed Evar
David Barill�, Maria Giulia Pascucci, Stefano Brizzi, Mariachiara Tamburrini, Efrem Civilini;
Humanitas University, Milan, Italy

BACKGROUND: The shift towards an EVAR-first approach for infrarenal aortic aneurysms is still burdened by increased descriptions of late complications requiring reintervention. Endovascular bailout procedures are a possibility, however, open surgical conversion is indicated in selected cases, despite being associated with considerable invasiveness and procedural challenges. Fast Track (FT) protocols have proven effective in reducing the perioperative surgical stress of standard treatment of infrarenal aortic aneurysms. The aim of this single-center study is to evaluate the effectiveness of a specifically designed FT applied to open conversion.
METHODS: We retrospectively analyzed patients who underwent elective open surgical conversion from 2017 to 2022, managed with a FT protocol, implemented by simplified endoprosthesis removal techniques aimed at minimizing its invasiveness. The primary outcome is the analysis of clinical results at 30-day. The secondary endpoint was the length of hospital stay.
RESULTS: 15 patients were analyzed (age 77�5 years, ASA score 2.2�0.8); 57.1% of them were treated for type II endoleak. 50% had previously undergone at least one secondary endovascular procedure (range 1-3). In 71.4% of cases, the aortic clamping was infrarenal. The endoprosthesis was partially explanted in 12 patients with a simplified explantation technique, while two patients underwent total explantation due to endoprosthesis infection (n=1) or type I endoleak (n=1). We recorded no admissions to the Intensive Care Unit, no major complications, and no mortality. The mean length of hospital stay was 5.4�2.3 days.
CONCLUSIONS: Despite the technological advances, endoleak remains the Achilles� heel of EVAR. The application of a dedicated Fast Track protocol makes open conversion a valid option, and an alternative to complex and repeated endovascular bailout strategies.

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