Failure modes and secondary endovascular interventions after endovascular aortic repair

Endovascular repair has a firmly established role in the treatment of aortic disease. The development of endovascular devices to treat even complex aortic disease has broadened the panorama of repair significantly but has also introduced new forms of repair failure. Standard devices for EVAR and TEVAR have also been enhanced, providing better adaptation to the anatomy treated, smaller delivery systems, more intuitive delivery designs as well as improved features to facilitate precise delivery of the device. Improved imaging techniques also contribute to improved outcomes. The main subtypes of complications are still related to either endoleaks or stentgraft stenosis/occlusions. With more complex repairs also follow more complex failure modes. Choosing and planning a repair according to the specific patient anatomy without compromising the sealing zones of the repair remains vital to provide long-term durability. Continued surveillance is mandatory to improve not only repair durability but also to increase the knowledge of progressive aortic disease.