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Background  Early morbidity and mortality are generally lower after endovascular aortic repair (EVAR), than after open repair but re-interventions and late complications are more common. The aim of the present study was to make a detailed description of re-interventions after EVAR-including incidence, indications, procedures, and outcome-with special reference to non-access-related re-interventions.    Methods  This is a retrospective single-center cohort study of re-interventions after standard EVAR with special reference to non-access-related re-interventions. Consecutive patients ( n  = 405) treated with standard EVAR for non-ruptured ( n  = 337) or ruptured ( n  = 68) infrarenal aneurysms between 2005 and 2013 were analysed. Median follow-up was 29 months (range 0–108).    Results  Eighty-nine patients (22 %) underwent 113 re-interventions during follow-up. Twenty-seven patients (7 %) had 28 access related re-intervention, 65 patients (16 %) had 85 non-access related reinterventions. Non-access related re-interventions were more common in ruptured aneurysms than in unruptured aneurysms (22 vs. 15 %,  p  = 0.002). The most frequent indications were endoleak type I ( n  = 19), type II ( n  = 21), or type III ( n  = 5); stent graft migration ( n  = 9); and thrombosis ( n  = 14). The most frequent procedures were embolization of endoleak type II ( n  = 21), additional iliac stent graft ( n  = 19), proximal extension ( n  = 12), thrombolysis ( n  = 8), iliac limb bare-metal stenting ( n  = 6), and stent graft relining ( n  = 7). Endovascular technique was used in 83 % of re-interventions.  Thirty-day mortality after non-access-related re-interventions was 15 % when initiated from symptoms (rupture or infection) and 0 % when initiated from follow-up findings ( p  = 0.014). Cumulative survival five years after EVAR was 72 % in patients with a re-intervention and 59 % in patients without ( p  = 0.21).    Conclusions  Non-access-related re-intervention rates are still considerable after EVAR and more frequent after ruptured aneurysms. Endoleak embolization is the most frequent procedure, followed by additional iliac stent grafts. Outcomes after re-interventions are generally good, except when initiated by rupture or infection.

Re-interventions after endovascular aortic repair for infrarenal abdominal aneurysms: a retrospective cohort study