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P6: Plenary Session 6

SS16 - The iConveRt Registry: Insights from a Prospective Multicenter Study on Open Conversions after EVAR

Friday, June 6, 2025
10:20 AM – 10:31 AM CT
Location: Morial CC, First Floor, Great Hall A
Objectives: The number of late open conversions (LOC) after EVAR appears to be increasing. Additionally, advanced endoaortic techniques such as fenestrated EVAR (F-EVAR) are now widely utilized and may develop complications necessitating open repair. The purpose of this study is to report the 3-year results of a national prospective registry on LOC after EVAR.

Methods: The iConveRt (Italian Conversion Registry) initiative began in January 2022 and includes 36 Vascular Centers. All consecutive patients undergoing LOC were prospectively entered into a browser-based, meta-data driven electronic data capture database (REDCap). Data were entered pre-operatively, post-operatively, at 1-month follow-up, and at each follow-up evaluation.

Results: From January 2022 to December 2024, 165 patients underwent LOC at participating institutions. Mean age at LOC was 786.8 years (95.15% males). Mean American Society of Anaesthesiology score was 3.320.73.
Median time from initial EVAR to LOC was 74.77 months (IQR 32-108). Endovascular repair was attempted prior to LOC in 36.2% of cases. Median aneurysm diameter at conversion was 79mm (IQR 60-90). Urgent LOC was required in 31.7% of cases.
The primary indication for LOC was endoleak in 80.6% of cases, predominantly type Ia (40%) and type II (38.8%). Endograft infection accounted for 14.5% of cases (Fig.1). Complex EVAR was present in 12/165 (7.27%) patients undergoing LOC (6 F-EVAR, 4 branched-EVAR, and 2 Chimney-EVAR). Complete endograft explantation was performed in 33.9% of cases, while 66.1% underwent partial explantation (52.1%) or graft preservation (semi-conversion, 13.9%) (Fig.2). All complex EVAR cases involved partial endograft explantation. Infrarenal aortic clamping was performed in 40.8% of cases.
The overall 30-day mortality rate was 9.7% (15.4% for urgent cases vs. 7.1% for elective cases, P=.09). Mean length of stay was 2884 days. Semi-conversions did not demonstrate an advantage in terms of 30-day death (8.70% for semi-conversiosn vs 9.86% for endograft explantations; P=.86), or length of stay (median 8 days IQR 6-11 vs. 9 days IQR 7-15; P=.12).
During the mean follow-up of 22.8714.27 months, we recorded an overall mortality rate of 19.8%.

Conclusions: The current LOC population is characterized by a long median time from initial EVAR to LOC (>6 years) and a large median aneurysm diameter (80 mm). Complex EVAR constitutes a growing proportion of LOC cases (7.27%). Partial endograft explantations predominate, while semi-conversions are infrequent and do not demonstrate an early advantage. Larger studies and extended follow-up are required to validate these findings in this growing, high-risk population with concerning postoperative mortality rates.