Open Access

Introduction: While the EndoVascular Aneurysm Sealing (EVAS) technology for the treatment of abdominal aortic aneurysms initially provided promising results, further follow-up revealed an increased rate of endoleaks and migrations, resulting in open conversions. In the present study we evaluated the technical features as well as the clinical results of 32 EVAS explantations. Methods: From June 2014 to November 2018, 32 patients who had an open conversion due to EVAS complications were enrolled in the single-center study. Besides the reasons for the conversion and the demographic data of the patients, the duration of the procedure, the blood loss, the 30-day/total mortality, the days in the intensive care unit, as well as the (post-) operative complications were recorded. Results: The diagnosis (diagnoses) of 32 conversions were as follows: 22 (= 69%) migrations, 15 (= 47%) endoleaks, nine (= 28%) cases of aneurysm growth, six (= 17%) acute ruptures, and four (= 12%) stent-graft infections. On average, the initial EVAS implantation had taken place 25 months (range 0-52) before the explantation. The patient population (age 72 +/- 8 years) included six women and 26 men, 66% were classified ASA III and 25% ASA IV, respectively. The median duration of the explanation procedures was 168 minutes (7-417) and the median blood loss 1100 ml (500-5000). All EVAS stent-grafts were removed in toto. 28 patients received a bifurcated graft, three a tube graft (one with renovisceral debranching); one patient died intraoperatively before the aortic reconstruction could be completed. 30-day mortality was 28% (= 9/32): six patients died due to a multi-organ failure, while three patients suffered from an uncontrollable bleeding with haemodynamic instability. During a median follow-up of 12 months (0-38), the overall mortality stayed at 28%. The patients had a median postoperative stay of three days (0-35) in the intensive care unit; in total they stayed a median of 13 days (1-93) in the hospital. In addition to the abovementioned fatal complications, there were three cases of ischemic colitis, one case of acute ischemia of the lower limb, one stroke and one postoperative wound infection. Conclusion: To the authors best knowledge, the series represents the largest single center experience worldwide. The majority (84%) of patients received the EVAS explantation due to migration and/or endoleak, with the initial implantation dating back a median of over two years. Although the EVAS stent-graft with its surrounding endobags largely prevents ingrowth into the aorta, making it technically relatively easy to remove, the explantation remains a high-risk procedure. Nevertheless, the comparatively high 30-day mortality rate of 28% must be interpreted with caution, due to the large proportion of acute ruptures (4/9) as well as the overall diseased patient population.