Outcomes of Open Surgical Repair for Post-EVAR Endoleaks: A Retrospective Cohort Study with Mid-Term Follow-Up

BACKGROUND: To assess perioperative safety and mid-term durability of open surgical repair (OSR) as a salvage therapy for endoleaks after failed endovascular aneurysm repair. METHODS: A single-center retrospective analysis was performed on 23 consecutive patients (21 males, 2 females; mean age 65.6 ± 10.6 years) undergoing OSR for persistent endoleaks at Nanjing Drum Tower Hospital between May 2018 and July 2023. Endoleak subtypes included type I (n = 7), type II (n = 14), type III (n = 1), and type IV (n = 1). Primary end points were 30-day mortality and major adverse events, with secondary end points encompassing 3-year survival and reintervention rate. RESULTS: The 30-day mortality of the cohort reached 13.0% (3/23), attributed to pulmonary infection (n = 1), circulatory collapse (n = 1), and septic shock (n = 1). Notably, 34.8% (8/23) developed pulmonary complications, whereas 21.7% (5/23) experienced acute kidney injury. At a median follow-up of 30.6 months (interquartile range 25.4-38.9), the 3-year overall survival rate was 86.9%. No aorta-related deaths occurred during the follow-up; only 1 patient (4.3%) required secondary intervention for distal iliac artery redilation. CONCLUSION: OSR constitutes a definitive solution for endoleak management postendovascular aneurysm repair , demonstrating acceptable perioperative risk and durable mid-term outcomes. Although pulmonary and renal complications remain noteworthy short-term concerns, the technique offers low reintervention rates and stable survival trajectories, particularly in the absence of aorta-related mortality.