Background: The early survival benefits of endovascular aneurysm repair (EVAR) appear to diminish over time, and late aneurysm-related mortality remains a significant concern. Our aim is to determine the rate of secondary interventions (SI) and assess compliance with post-EVAR surveillance.

Methods: This retrospective cohort study included consecutive patients who underwent elective EVAR between February 2009 and May 2019 at a tertiary center. The primary outcomes were freedom from SI and compliance with follow-up (imaging performed within a time interval of no more than 18 months). Secondary outcome was overall patient survival.

Results: A total of 214 patients underwent EVAR, with a median follow-up of 44 months. During this period, 42 SI were performed in 25 patients. Of all SI, 33.3% (14/42) were due to symptomatic complications. Freedom from SI was 96.3±1.3% at 30 days and 93.6±1.7%, 90.3±2.2% and 85.9±3.0 at 1, 3 and 5 years, respectively. Endoleaks were the main cause of SI after EVAR (N.=26), primarily type 1 and type 2. At 5 years, patient survival rates were similar (76.7±4.1% vs. 84.4±7.2%, P=0.386). Compliance with surveillance was 80.4±2.9% at 1 year, and 37.7±5.4% at 5 years.

Conclusions: SI after EVAR were frequent, with endoleaks being the leading cause and associated with cases of aneurysm sac rupture. Although compliance with surveillance decreases over longer follow-up periods, the impact of this trend on long-term outcomes after EVAR warrants further investigation.