Late open conversions after endovascular abdominal aneurysm repair in an urgent setting.

OBJECTIVES: We report a multicenter experience of urgent late open conversion (LOC), with the goal of identifying the mode of presentation, technical aspects, and outcomes of this cohort of patients. METHODS: A retrospective analysis of endovascular aneurysm repair (EVAR) requiring LOC (>30 days after implantation) from 1996 to 2016 in six vascular centers was performed. Patients with aneurysm rupture or other conditions requiring urgent surgery (<24 hours) were included. Patient demographics, time interval between EVAR and LOC, endograft characteristics, previous attempts at endovascular correction, indications, operative technique, 30-day mortality and morbidity, and long-term survival were analyzed. RESULTS: There were 42 patients (88.1% men; mean age, 75.8 ± 9.0 years) included. Among the 42 explanted grafts, 33 were bifurcated, 1 tube, 6 aortouni-iliac, and 2 side-branch devices. Suprarenal fixation was present in 78.6%. Twelve patients (28.6%) underwent endovascular reintervention before LOC. Indications for urgent LOC were aneurysm rupture in 24 of the 42 cases (57.1%), endograft infection in 11 (26.2%), endoleak associated with aneurysm growth and pain in 6 (14.3%), and recurrent endograft thrombosis in 2 (4.8%). The proximal aortic cross-clamping site was infrarenal in 38.1% of cases, suprarenal in 19.1%, and supraceliac in 42.9%. Complete removal of the endograft was performed in 32 patients (76.2%) and partial removal in 10 (proximal preservation in 7 of 10). Reconstructions were performed with Dacron grafts in 33 of the 42 cases, cryopreserved arterial allografts in 5, and endograft removal associated with prosthetic axillobifemoral bypass in 4. The 30-day mortality was 23.8%; hemorrhagic shock was an independent risk factor of early mortality (odds ratio, 10.5; 95% confidence interval, 1.5-73.7; P = .018). During a mean follow-up of 23.9 ± 36.0 months, two late aneurysm-related deaths occurred. The estimated 1- and 5-year survival rates were 62.1% and 46.1%, respectively. CONCLUSIONS: Urgent LOC after EVAR are associated with high postoperative mortality rates and poor long-term survival. Further studies are necessary to define the timing and the best treatment option for failing EVAR.

Synovial cysts of the hip.

BACKGROUND: Synovial cysts of the hip are relatively rare lesions comparing to other joints. Patients are usually asymptomatic, but in some cases symptoms such as pain and/or compression of vessels or nerve could be present. Purpose of the study was to define clinical features and optimal management of synovial cyst of the hip joint through an accurate review of the literature. METHODS: We present three consecutive cases treated with three different therapeutic strategies: surgical excision, wait-and-see and needle aspiration. An accurate review of the literature has been performed to identify patients who had been treated for synovial cyst of the hip. RESULTS: Due to the rarity of the disease, there are no significant data in literature supporting the gold standard of treatment. Treatment of the synovial cyst depends on their size, symptoms and comorbidities. CONCLUSIONS: Most of the Authors recommend surgical treatment for symptomatic synovial cysts and needle aspiration as an option treatment in asymptomatic patients without vessel or nerve compression. In patients that referred symptoms in correspondence with the hip joint, not strictly related with radiograph findings, a CT or MRI examinations should be performed to exclude possible differential diagnosis.