Strategy to avoid open surgical conversion after endovascular aortic aneurysm repair for patients with infrarenal abdominal aortic aneurysm

Purpose@#Open surgical conversion (OSC) is the last treatment option for patients with endovascular aneurysm repair (EVAR) failure. We investigated the underlying causes of EVAR failure requiring OSC and attempted to determine strategies to avoid OSC after EVAR. @*Methods@#We retrospectively reviewed the database of patients who underwent OSC after EVAR from 2005 to 2018 in a single institution. Twenty-six OSCs were performed in 24 patients (median age, 74.5 years; 79.2% of males) who had undergone standard EVAR. We investigated pre-, intra-, and postoperative computed tomography or angiographic images and outcomes of the OSCs. @*Results@#Two main indications for OSC were persistent endoleak (50.0%) and endograft infection (EI) (38.5%). All 13 patients who underwent OSC due to endoleaks received EVAR outside of indications for use. Among 10 patients who underwent OSC due to EI, we found overlooked infection sources in 7 (70.0%) at the time of EVAR or during the surveillance period.OSC was performed at a median of 31.8 months (interquartile range, 9.4–69.8) after EVAR as an emergency (15.4%) or elective (84.6%) surgery. Aortic endograft was removed in 84.6% of cases (totally, 57.7%; partially, 26.9%), whereas it was preserved in 4 cases (15.4%). After 26 OSCs, 2 early deaths (7.7%) and 2 aortoenteric fistulae (7.7%) developed as major complications. @*Conclusion@#OSC after EVAR was associated with relatively higher perioperative morbidity and mortality. To avoid OSC after EVAR, we recommend careful assessment of coexisting infection sources and avoidance of EVAR for patients with especially unfavorable anatomy for EVAR, particularly the in proximal neck.

Antihypertensive Effect of Bunazosin(Detantol(R)) in Essential Hypertension

Antihypertensive effect of Bunazosin was evaluated in 23 patients with essential hypertension. Systolic blood pressure decreased from 175.5+/-16.9mmHg to 167.5+/-30.2mmHg after 4 weeks and to 165.4+/-29.7mmHg(p<0.05) after 8 weeks of medication. Diastolic blood pressure decreased from 105.6+/-9.7mmHg to 98.6+/-11.6mmHg(p<0.05) after 4 weeks and to 98.1+/-12.2mmHg(p<0.05) after 8 weeks of medication. Heart rate and serum lipid profiles did not change significantly. Transient side effects such as nausea(two cases), headache (one case), and weakness(one case) were observed, but there were no significant side effects. Therefore Bunazosin seemed to be effective in lowering blood pressure without reflx tachycardia, changes of serum lipie profiles, and significant side effects.