Tips and Tricks to Facilitate Late Open Surgical Conversion after Endovascular Aortic Aneurysms Repair

Endovascular repair has significantly improved the treatment of aortic aneurysms, particularly in older and high-risk patients. However, many studies have not found significant differences in long-term outcomes when comparing open and endovascular repair methods. Additionally, endovascular repair is associated with a higher rate of aortic-related reinterventions compared to open repair (OR), sometimes necessitating late open surgical conversion (LOSC). The increasing number of endovascular aortic aneurysm repairs exposes vascular surgeons to a growing number of patients requiring late open surgical conversion (LOSC) after previous endovascular aneurysm repair (EVAR) or thoracic endovascular aortic repair (TEVAR). LOSC following endovascular procedures is associated with higher perioperative mortality and complication rates compared to primary open repair of aortic aneurysms. This review summarizes the current knowledge, indications, possibilities, and techniques for LOSC after initial endovascular procedures. While the incidence of complications requiring LOSC remains relatively low, the number of endovascular procedures performed has increased significantly over the last decade, suggesting a rise in LOSC procedures as well. Due to the complexity involved, LOSC procedures should be performed in high-volume centers by highly experienced vascular surgeons. This underlines the importance of educating the younger generation of vascular surgeons in both endovascular and open aortic surgery.