Objective  To analyze causes of secondary surgery after endovascular aneurysm repair(EVAR).

  Methods  The clinical data and follow-up results of 171 patients with subrenal abdominal aortic aneurysm (AAA) treated with EVAR were retrospectively analyzed, among whom 20 patients received secondary surgical intervention. The reasons for the secondary surgical intervention were analyzed, and how to reduce the incidence of postoperative complications of EVAR was discussed.

  Results  Out of 20 patients with secondary surgeries, type Ⅰ leakage occurred in 8 cases(typeⅠa in 6 cases and type Ⅰb in 2 cases), type Ⅱ leakage in 2 cases (arterial blood re-entry of inferior mesenteric artery), Ⅲ type of leakage in 2 cases (left iliac branch retracting into the lumen), thrombotic occlusion of left iliac branch subject to stent thrombosis in 2 cases, iliac vein thrombosis in 4 cases, and iliac stenosis in 2 cases. The results of regression analysis showed that postoperative leakage and distal ischemia were the main reasons for the secondary operation in EVAR patients. The combination of endovascular repair and strict follow-up are the key to improve the safety and effectiveness of the operation.

  Conclusion  EVAR has a good short-term effect, but postoperative internal leakage and distal ischemia are still the key factors affecting its efficacy, which may lead to secondary operation.