Complications and reinterventions after EVAR: are they decreasing in incidence?

Endovascular repair of infrarenal abdominal aortic or aortoiliac aneurysms (EVAR) using currently available stent-grafts has proven to be a safe, effective, and durable method with great acceptance among vascular surgeons. Comparison of elective EVAR versus "open" elective abdominal aortic aneurysm (AAA) repair showed significant advantages for EVAR in terms of perioperative complications, postoperative care, and early patient recovery. However, a remarkable incidence of mid- and long-term EVAR-related complications remains. Additionally, several strategies have been investigated to overcome limitations related to very short aortic neck anatomies such as fenestrated or chimney grafts expanding the application of endografts in hostile anatomies. The outcome of these alternative techniques is still under evaluation and any conclusion seems for the moment premature. The aim of the present article was to present an overview about the current status of the durability of EVAR and to attempt to answer the question about the frequency of late interventions.