Objective: Complex abdominal aortic aneurysms (cAAA) pose a clinical challenge. The aim of this study was to assess the 30 day mortality and morbidity rates for open aneurysm repair (OAR) and fenestrated or branched endovascular aortic repair (F/B-EVAR), and the effect of hospital volume in patients with asymptomatic cAAA in Switzerland. Methods: Retrospective, cohort study using data from Switzerland's national registry for vascular surgery, Swissvasc, including patients treated from 1 January 2019 to 31 December 2022. All patients with asymptomatic, true, non-infected cAAA were identified. The primary outcome was 30 day mortality and morbidity rates reported using the Clavien-Dindo classification. Outcomes were compared between OAR and F/B-EVAR after propensity score weighting. Results: Of the 461 patients identified, 333 underwent OAR and 128 underwent F/B-EVAR for cAAA. At 30 days, the overall mortality rate was 3.3% after OAR and 3.1% after F/B-EVAR (p = .76). Propensity score weighted analysis indicated similar morbidity rates for both approaches: F/B-EVAR (OR 0.69, 95% CI 0.45- 1.05, p = .055); intestinal ischaemia (1.8% after OAR, 3.1% after F/B-EVAR, p = .47) and renal failure requiring dialysis (1.5% after OAR, 5.5% after F/B-EVAR, p = .024) were associated with highest morbidity and mortality rates. Treatment specific complications with high morbidity were abdominal compartment syndrome and lower limb compartment syndrome following F/B-EVAR. Overall treatment volume was low for most of the hospitals treating cAAA in Switzerland; outliers with increased mortality rates were identified among low volume hospitals. Conclusion: Comparable 30 day mortality and morbidity rates were found between OAR and F/B-EVAR for cAAA in Switzerland; lack of centralisation was also highlighted. Organ specific complications driving death were renal failure, intestinal ischaemia, and limb ischaemia, specifically after F/B-EVAR. Treatment in specialised high volume centres, alongside efforts to reduce peri-procedural kidney injury and mesenteric ischaemia, offers potential to lower morbidity and mortality rates in elective cAAA treatment.

Thoracic endovascular aortic repair (TEVAR) is the standard treatment for pathologies in the distal aortic arch and descending aorta. In up to 50% of cases a landing in Ischimaru zone 2 is necessary to achieve a safe seal, whereby perfusion of the left subclavian artery (LSA) should be maintained to prevent stroke and ischemia. For revascularization of the LSA open surgical procedures, such as a carotid-subclavian/axillary bypass and LSA transposition as well as endovascular approaches, such as branched (bTEVAR) and fenestrated endoprostheses (fTEVAR) are available. Endovascular techniques include custom made (CMD), off the shelf and physician-modified devices (PMD), with the latter being subdivided into ex situ and in situ modifications. Another method is the parallel graft technique. The choice of technique depends on the anatomy of the patient, the technical possibilities and the expertise of the surgeon/interventionalist. The bTEVAR prostheses are technically demanding and often require additional manipulation. The fTEVAR prostheses require a closer alignment to the aortic wall and therefore necessitate a greater distance from the aortic pathology. The CMD prostheses offer maximum precision but are expensive and not always available. Off the shelf and PMD prostheses offer more flexibility, whereby PMDs require special expertise and equipment. The parallel graft technique is used as a bailout strategy. Future developments are aimed at standardized, more cost-effective solutions but long-term results are still lacking. Larger studies are needed to determine the optimal technique. This article provides an overview of current endovascular debranching techniques for LSA and discusses the advantages and disadvantages.

Zusammenfassung Die thorakale endovaskuläre Aortenreparatur (TEVAR) ist die Standardtherapie für Pathologien im distalen Aortenbogen und der Aorta descendens. In bis zu 50 % der Fälle ist eine Landung in der Ischimaru-Zone 2 notwendig, um eine sichere Abdichtung zu erreichen, wobei die Perfusion der linken A. subclavia (LSA) erhalten bleiben sollte, um Schlaganfälle und Ischämien zu vermeiden. Zur Revaskularisierung der LSA stehen offene chirurgische Verfahren wie der karotidosubklaviale/axilläre Bypass und die LSA-Transposition sowie endovaskuläre Ansätze wie gebranchte (bTEVAR) und fenestrierte Endoprothesen (fTEVAR) zur Verfügung. Endovaskuläre Techniken umfassen „custom-made“ (CMD), Off-the-Shelf- und Physician-modified-Devices (PMD), wobei letztere in Ex- und In-situ-Modifikationen unterteilt werden. Eine weitere Methode ist die Parallelgrafttechnik. Die Wahl der Technik hängt von der Anatomie des Patienten, den technischen Möglichkeiten und der Expertise des Behandlers ab. bTEVAR-Prothesen sind technisch anspruchsvoll und erfordern oft zusätzliche Manipulationen. fTEVAR benötigen eine engere Lagebeziehung zur Aortenwand und erfordert daher einen größeren Abstand zur Aortenpathologie. CMD-Prothesen bieten höchste Präzision, sind jedoch teuer und nicht immer verfügbar. Off-the-Shelf- und PMD-Prothesen bieten mehr Flexibilität, wobei PMDs spezielle Expertise erfordern. Die Parallelgraft-Technik wird als Bailout-Strategie eingesetzt. Zukünftige Entwicklungen zielen auf standardisierte, kostengünstigere Lösungen ab, jedoch fehlen noch Langzeitergebnisse. Größere Studien sind notwendig, um die optimale Technik zu bestimmen. Der Artikel gibt einen Überblick über die aktuellen endovaskulären Debranching-Techniken der LSA und diskutiert deren Vor- und Nachteile.

BACKGROUND: When Cox regression models are used to analyse time-to-event data, the proportional hazard assumption (PHA) must be reassured to obtain valid results. Transparent reporting of the statistics used is therefore essential to interpret research. This study aimed to assess the quality of statistical reporting and testing of the PHA in subgroup analysis of surgical randomised controlled trials (RCTs). METHODS: All published articles (see appendix 1) in the top quartile (25%) of surgical journals from 2019 to 2021 were screened in a literature review according to the ClarivateTM journal citation report impact factor. Subgroup analyses of surgical RCT data that used Cox models were identified. Statistical reporting was rated using a previously established 12-item PHA Reporting Score as our primary endpoint. For original surgical publications, the PHA was formally tested on reconstructed time-to-event data from Kaplan-Meier estimators. Methodological reporting quality was rated according to the CONSORT statement. Digitalisation was only possible in studies where a Kaplan-Meier estimator including numbers at risk per time interval was published. All results from the subgroup analyses were compared to primary surgical RCT reports and benchmark RCTs using Cox models published in the New England Journal of Medicine and The Lancet. RESULTS: Thirty-two studies reporting secondary subgroup analyses on surgical RCT data using Cox models were identified. Statistical reporting of surgical subgroup publications was significantly inferior compared to original benchmark publications: median PHA Reporting Score 50% (interquartile range [IQR]: 39 to 58) vs 58% (IQR: 42 to 67), p <0.001. The subgroups did not differ in comparison to primary surgical RCTs: median PHA Reporting Score 50% (IQR: 39 to 58) vs 42% (IQR: 33 to 58), p = 0.286. Adherence to the CONSORT reporting standards did significantly differ between subgroup studies and benchmark publications (p <0.001) as well as between subgroup studies and primary surgical RCT reports: 13 (12.5 to 14) vs 13 (IQR: 11 to 13), p = 0.042. CONCLUSION: Statistical methodological reporting of secondary subgroup analyses from surgical RCTs was inferior to benchmark publications but not worse than primary surgical RCT reports. A comprehensive statistical review process and statistical reporting guidelines might help improve the reporting quality.

The risk of bridging stent occlusion after branched endovascular aortic repair (BEVAR) remains an issue. Currently, there is no clear recommendation on what kind of antithrombotic therapy should be installed after BEVAR. The aim of the study was to estimate the impact of postoperative antithrombotic therapy on bridging stent occlusion rate after elective BEVAR. An international multicenter retrospective analysis was performed in 4 European tertiary vascular units. All reno-visceral target vessels treated with bridging stents of patients undergoing elective BEVAR with the use of off-the-shelf or custom-made branched stent-grafts for pararenal aortic aneurysms (PAAs), type Ia endoleaks after previous EVAR, and thoracoabdominal aortic aneurysms (TAAA) between January 2014 and December 2022 were included. Primary outcome was freedom from bridging stent occlusion and its correlation with postoperative antithrombotic therapy. Secondary outcomes were overall survival and identifying target vessel and bridging stent characteristics, which may have a higher risk for bridging stent occlusion according to the PRINCE2SS recommendation. Follow-up information was obtained for all patients per 31st of December 2022. In total, 120 patients (90 male) with a median age of 72 (interquartile range [IQR]=67-77) years were included. Two hundred eighty-nine external and 127 internal branches were used for 416 target vessels. The median follow-up was 21 months (IQR=9-48) with a follow-up index of 1.0. During follow-up, 24 (5.8%) primary bridging stent occlusions (left renal artery [LRA]=10, right renal artery [RRA]=7, superior mesenteric artery [SMA]=3, truncus coeliacus [TC]=4) were found. The risk of renal bridging stent occlusion is significantly higher compared with visceral bridging stent, p=0.013. The occlusion rate was 7.8% for renal branches and 1.5% for visceral branches at 1 year and 10.6% and 3.7% at 5 years, respectively. The multivariable Cox proportional hazard model on bridging stent occlusion showed that there was no significant difference between the used antithrombotic strategies. No antithrombotic therapy was significantly associated with bridging stent occlusion, whereas no evidence for superiority of any other antithrombotic therapy was found. Overall, the bridging stents’ occlusion rate was low. We found a significantly higher occlusion rate in renal arteries compared with the visceral ones. Clinical Impact Based on our study, no antithrombotic therapy is significantly associated with bridging stent occlusion, and no evidence of the superiority of other antithrombotic therapy exists. Nevertehless, due to the low number of bridging stent occlusions, this study can neither support nor reject the PRINCE2SS recommendations. Further studies with larger cohorts are needed to determine clear guideliness of the best antithrombotic treatment regimen after complex enfovascular aortic repair.

Objective: Current guidelines recommend diameter monitoring of small and asymptomatic abdominal aortic aneurysms (AAAs) due to the low risk of rupture. Elective AAA repair is recommended for diameters >= 5.5 cm in men and >= 5.0 cm in women. However, data supporting the efficacy of elective treatment for all patients above these thresholds are diverging. For a subgroup of patients, life expectancy might be very short, and elective AAA repair at the current threshold may not be justified. This study aimed to externally validate a predictive model for survival of patients with an asymptomatic AAA treated by endovascular aneurysm repair (EVAR). Methods: This was a multicentre international retrospective observational cohort study. Data were collected from four European aortic centres treating patients between 2001 and 2021. The initial model included age, estimated glomerular filtration rate (eGFR), and chronic obstructive pulmonary disease (COPD) as independent predictors for survival. Model performance was measured by discrimination and calibration. Results: The validation cohort included 1 500 patients with a median follow up of 65 months, during which 54.6% of the patients died. The external validation showed slightly decreased discrimination ability and signs of overfitting in model calibration. However, a high risk subgroup of patients with impaired survival rates was identified: octogenarians with eGFR < 60 OR COPD, septuagenarians with eGFR < 30, and septuagenarians with eGFR < 60 and COPD having survival rates of only 55.2% and 15.5% at five and 10 years, respectively. Conclusion: EVAR is a valuable treatment option for AAA, especially for patients unsuitable for open repair. Nonetheless, not all these patients will benefit from EVAR, and an individualised treatment recommendation should include considerations on life expectancy. This study provides a risk stratification to identify patients who may not benefit from EVAR using the present diameter thresholds.

Background: Complex endovascular repair with fenestrated or branched stent grafts is a common approach for treating various types of aortic aneurysms. Bridging stent grafts (BSs) are crucial in connecting aortic endoprosthesis to target vessels, yet current options have demonstrated significant complications. Objective: This retrospective single-center study evaluates the initial outcomes and durability of the iCover stent graft (iCover-SG) when used as a BS in fenestrated endovascular aneurysm repair (FEVAR). Methods: Retrospective analysis screened procedures for complex aortic aneurysms between August 2021 and January 2024. Patients who underwent FEVAR with iCover-SG as BS were included. Primary and secondary endpoints focused on freedom from iCover-SG-related target vessel instability, technical success, and postoperative outcomes. Results: Within the cohort of 28 patients, 94 iCover-SGs were used as BS, supplying 87 target vessels. The freedom from iCover-SG-related target vessel instability throughout the study reached 94% (82/87). Technical success rates were notably high, with primary success achieved in 94% of cases and secondary success in 99%. Over the follow-up duration, there were instances necessitating reintervention related to iCover-SG, including 4 cases of endoleak, 2 cases of T1cEL, and 2 cases of T3cEL. In-hospital mortality was 7% (n=4), with 2 cases attributed to intraoperative complications. Importantly, no deaths were directly attributed to iCover-SG-related issues. Conclusion: The iCover-SG demonstrates promising initial outcomes as a BS in FEVAR, with high technical success rates and satisfactory rates of target vessel instability. Continued monitoring and further studies are warranted to assess long-term durability and outcomes. Clinical Impact This study shows that the iCover stent graft achieves satisfactory technical success and target vessel stability in the short- and mid-term when used as a bridging stent graft in FEVAR procedures. Its successful integration into clinical practice broadens the range of available options, providing clinicians with more versatile tools for managing complex endovascular aortic aneurysms. This expanded selection of bridging stent grafts allows for more personalised treatment strategies, improving procedural precision and patient outcomes. The iCover stent graft’s reliable performance highlights its potential as a valuable addition to current endovascular techniques, ultimately enhancing patient care in challenging cases.

Objective: Vascular surgery registries report on procedures and outcomes to promote patient safety and drive quality improvement. International registries have contributed significantly fi cantly to the VASCUNET collaborative abdominal aortic aneurysm (AAA) outcome projects. This scoping review aimed to outline the national registries in vascular surgery that currently participate in the VASCUNET collaborative AAA projects. Methods: A scoping review of all published VASCUNET AAA studies and validation reports between 1997 and 2024 was undertaken. A survey was conducted among representatives of the international vascular registries contributing to VASCUNET collaborative AAA projects. Results: Currently, vascular registries from 10 countries (Australia, Denmark, Finland, Hungary, Iceland, New Zealand, Norway, Sweden, Switzerland, and the UK) contribute to the current VASCUNET collaborative AAA project, of which eight have national coverage. In the past, three countries (Germany, Malta, and Italy) have participated in previous VASCUNET AAA projects, and a further three countries (Serbia, Greece, and Portugal) have planned participation in future projects. External validity is high for all current registries, with most reporting rates of > 90%. The majority have internal validation processes to assess data accuracy. VASCUNET mediated validation has also been performed by the consortium for fi ve countries to date (Hungary, Sweden, Denmark, Malta, and Switzerland), for which a high degree of external and internal validity was identified. fi ed. Most registries have established mechanisms for data linkage with national administrative datasets or insurance claims datasets and contribute to quality improvement through regular reporting to participating centres. Conclusion: National vascular registries from nations participating in the VASCUNET collaborative AAA projects are largely comprehensive, with high case ascertainment rates and good quality data with internal quality assurance. This provides a template for new registries wishing to join the VASCUNET collaboration and a benchmark for future research.

PURPOSE:The treatment of infectious aortic disease is still challenging with open surgical debridement and reconstruction using biological, preferably autologous material, being the treatment of choice. However, these procedures are associated with high morbidity and mortality. Endovascular therapy is often considered a bridging method only, since the biologically inactive fabric of the covered stent grafts usually cannot be treated sufficiently with anti-infective agents in the event of a (obligate) consecutive secondary graft infection. This study aims to prove the feasibility of a physician-made pericardium stent graft ex-vivo. TECHNIQUE:A state-of-the-art TEVAR was modified by separating the fabric from the z-stents and suturing a hand-sewn bovine pericardium tube to the bare metal. Feasibility of preparation, re-sheathing, and delivery is demonstrated in an ex-vivo model. CONCLUSION:This first xenogeneic stent graft could be manufactured and deployed successfully. In the future this may provide a bridging alternative for high-risk patients with infected native aortic aneurysm or aortic fistulas, eventually followed by surgical or thoracoscopic/laparoscopic debridement. Further studies on simulators or animal models are needed to test the technique and investigate its long-term durability. Additionally, this study prompts reflection on whether materials currently used should be further developed to prevent graft infections.

Background: This study aims to identify circulating biomarkers by using proteomic analysis associated with sac shrinkage or expansion in patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs). Methods: Plasma samples were analysed from 32 patients treated with EVAR between 10/2009 and 10/2020. Patients were divided into two groups based on postoperative sac behaviour: sac shrinkage (≥5 mm reduction) and no shrinkage (stabilisation or expansion). Proteomic analysis was performed using high-resolution liquid chromatography-tandem mass spectrometry (LC-MS/MS), with abundant protein depletion to enhance the detection of low-abundant proteins. Results: Of the 32 patients, 20 exhibited sac shrinkage, and 12 showed no shrinkage. Proteomic analysis identified 632 proteins, with significant differential abundance observed after adjusting for relevant clinical parameters. Notably, neurogranin (NRGN) levels were significantly associated with hypertension and smoking, while casein alpha S1 (CSN1S1) levels varied with statin use. Differentially abundant proteins related to aortic diameter included calpastatin, SCUBE3, and ubiquitin-conjugating enzyme E2, among others. Conclusions: Proteomic profiling revealed distinct biomarker patterns associated with sac behaviour in EVAR-treated AAA patients. These findings suggest potential therapeutic targets for enhancing EVAR outcomes and underscore the need for further investigation into the biological mechanisms underlying aneurysm sac shrinkage and stability.

Objective: Although significant improvement in the success rate and durability of branched endovascular aortic repair (BEVAR) was recently reported, the risk of bridging stent occlusion remains relevant.1,2 The PRINCE2SS international consensus suggests a lifelong antithrombotic therapy, depending on target vessels' anatomical characteristics, the use of multiple stents, and the stent's length.3 In this multicentre international study, the aim was to analyse the risk of bridging stent occlusion after elective BEVAR depending on the antithrombotic therapy and compare it with the PRINCE2SS recommendation.

Objective. To analyze the epidemiological shifts in the incidence of ascending and arch aortic aneurysms (AA) treated with open surgery in the context of evolving endovascular options on a national basis. Methods. Between 1 January 2009 and 31 December 2018, 4388 cases were admitted to the hospital with either ruptured (r)AA or non-ruptured (nr)AA as the primary or secondary diagnosis. Patients were classified as having AA based on inclusion and exclusion criteria. Results. The age-standardized hospital incidence rates for treatment of nrAA were 7.8 (95% confidence interval (CI): 6.9 to 8.7) in 100,000 men and 2.9 (2.4 to 3.4) in 100,000 women and were stable over time. The overall raw in-hospital mortality rate was 2.0% and was significantly lower in males compared to women (1.6% vs. 2.8%, p = 0.015). Higher van Walraven scores (OR: 1.08 per point; 95%CI: 1.06 to 1.11; p = 0.001) and higher age (OR 1.05 per year; (95%CI: 1.02 to 1.07, p = 0.045) were significantly associated with hospital mortality. Conclusions. Endovascular surgery seems to have no influence on hospital incidence in patients treated with conventional surgery for AA in Switzerland. There was a significant reduction in in-hospital mortality in both men and women, with age and the von Walraven score being independent factors for worse outcomes.

Background/Objectives: Aneurysms and dissections of the iliac artery (ADIAs) are significant vascular conditions often associated with aortic pathologies. Despite their importance, reports on isolated iliac artery pathologies are rare. This study aimed to investigate the epidemiology of ADIA in Switzerland including treatment incidence and hospital outcomes. Methods: A retrospective analysis of diagnosis-related group (DRG) statistics from 2011 to 2018 in Switzerland was conducted, identifying all cases of ADIA while excluding those with concomitant treatment of aortic pathologies. Age-standardized incidence rates and treatment outcomes were assessed, with multivariable logistic regression performed to identify factors associated with hospital mortality. Results: From 2011 to 2018, 1037 ADIA cases were hospitalized in Switzerland. Incidence rates for elective treatment were significantly higher in men than women, increasing in men from 1.5 to 2.4 cases per 100,000 men (p = 0.007), while remaining stable in women at around 0.2 cases per 100,000 women. Acute treatment incidence rates were lower but still higher in men, at 0.9 cases per 100,000 men and 0.2 cases per 100,000 women. Crude hospital mortality rates were lower for endovascular repair than open surgical repair in both elective (0.8% vs. 3.1%, p = 0.023) and emergency treatment (6.7% vs. 18.4%, p = 0.045). Multivariable analysis showed that endovascular repair was associated with significantly reduced hospital mortality compared to open repair (OR 0.27, 95%-CI: 0.10 to 0.66, p = 0.006). Conclusions: This nationwide study of iliac artery pathologies shows that the treatment incidence was about 10 times higher in men than in women for elective procedures, but only about five times higher for emergency treatment. Endovascular procedures were associated with significantly lower hospital mortality than open procedures, while hospital mortality rates were comparable for men and women.

INTRODUCTION:Recommendations for surgical versus conservative treatment of asymptomatic carotid stenosis (ACS) are based on prospective randomized trials, some of which were performed several decades ago. However, during this time, "best medical treatment" (BMT) for conservative therapy of arteriosclerotic patients has evolved significantly. Because of the associated risk reduction of ACS, surgical therapy is increasingly being questioned. By identifying clinical and morphological risk parameters, subgroups could be identified that might, however, benefit from invasive therapy. Consequently, multidisciplinary therapy decision-making requires an increasingly patient-individualized approach.

Despite the development of fenestrated and branched endovascular aortic repair (f/bEVAR), the surgical management of thoraco-abdominal aortic aneurysms (TAAAs) remains a major challenge. The aim of this study was to analyse the hospital incidence and hospital mortality of patients treated for TAAAs in Switzerland. Secondary data analysis was performed using nationwide administrative discharge data from 2009–2018. Standardised incidence rates and adjusted mortality rates were calculated. A total of 885 cases were identified (83.2% nonruptured (nrTAAA), 16.8% ruptured (rTAAA)), where 69.3% were male. The hospital incidence rate for nrTAAA was 0.4 per 100,000 women and 0.9 per 100,000 men in 2009, which had doubled for both sexes by 2018. For rTAAA, there was no trend over the years. The most common procedure was f/bEVAR (44.2%), followed by OAR (39.5%), and 9.8% received a hybrid procedure. There was a significant increase in endovascular procedures over time. The all-cause mortality was 7.1% with nrTAAA and 55% with rTAAA. The mortality was lower for rTAAA when f/bEVAR or hybrid procedures were used. A ruptured aneurysm and higher comorbidity were associated with higher hospital mortality. This study demonstrates that the treatment approach has changed significantly over the observed period. The use of f/bEVAR nearly tripled in nrTAAA and doubled in rTAAA during this decade.

Introduction: Endovascular aortic repair (EVAR) is widely used as an alternative to open repair in elective and even in emergent cases of ruptured abdominal aortic aneurysm (rAAA). One of the most frequent complications after EVAR is type II endoleak (T2EL). In elective therapy, evidence-based therapeutic recommendations for T2EL are limited. Completely unclear is the role of T2EL after EVAR for rAAA (rEVAR). This study aims to investigate the significance of T2ELs after rEVAR. Patients and methods: This is a retrospective single-center data analysis of all patients who underwent rEVAR between January 2010 and December 2020 with primary T2EL. The outcome criteria were overall and T2EL-related mortality and reintervention rate as well as development of aneurysm diameter over follow-up (FU). Results: During the study period between January 2010 and December 2020, 35 (25%) out of 138 patients with rEVAR presented a primary postoperative T2EL (age 74±11 years, 34 males). At rupture, mean aneurysm diameter was 73±12 mm. Follow-up was 26 (0–172) months. The reintervention-free survival was 69% (95% confidence interval [CI]: 55%–86%) at 30 days, 58% (95% CI: 43%–78%) at 1 year, and 52% (95% CI: 36%–75%) at 3 years. In 40% (n=14), T2ELs resolved spontaneously within a median time of 3.4 (0.03–85.6) months. The overall and T2EL reintervention rates were 43% (n=15) and 9% (n=3), respectively. Within 30 days, 11 patients (31%) required reintervention, of which 2 were T2EL related. Aneurysm sac growth by ≥5 mm was seen in 3 patients (9%), and aneurysm shrinkage rate was significantly higher in sealed T2EL group (86% vs 5%, p<0.0001). The overall survival was 85% (95% CI: 74%–98%) at 30 days, 75% (95% CI: 61%–92%) at 1 year, and 67% (95% CI: 51%–87%) at 3 years. Six deaths were aneurysm related, while 1 was T2EL related within the first 30 days due to persistent hemorrhage. During FU, one more patient died due to a T2EL-related secondary rupture (T2EL-related mortality, 5.7%, n=2). Multivariable analysis revealed that arterial hypertension was associated with an increased risk for reintervention (hazard ratio [HR]: 27.8, 95% CI: 1.48–521, p=0.026) and age was associated with an increased risk for mortality (HR 1.14, 95% CI: 1.04–1.26, p=0.005). Conclusion: T2ELs after rEVAR showed a benign course in most cases. In the short term, the possibility of persistent bleeding should be considered. In the mid term, a consequent FU protocol is required to detect known late complications after EVAR at an early stage and to prevent secondary rupture and death.