Chastant R, Canaud L, Ozdemir BA, et al. - Treatment with endovascular aneurysm repair (EVAR) is provided to three of four patients with infrarenal abdominal aortic aneurysm. An increase in the incidence of secondary procedures and surgical conversions has been reported for a population theoretically unfit for open surgery. Researchers here sought the indications and outcomes of late open surgical conversions after EVAR in a high-volume tertiary vascular unit. In this retrospective single-center study, they assessed data from 62 consecutive patients (88.7% male; mean age: 77.5 years) who underwent a late open conversion between January 1996 and July 2018. The median duration since index EVAR was 38.5 months; suprarenal fixation was identified in 65% of stent grafts requiring late open conversion. Following were the identified indications: 22.6% type IA, 16.1% type IB, and 45.2% type II endoleaks; 12.9% graft thrombosis; and 14.5% endoprosthesis infection. Late open conversion is technically more complex than primary open surgery and is related with an acceptable perioperative risk when performed in a high-volume aortic surgical center. Excellent early and late outcomes were reported in correlation with elective open conversion. Perioperative morbidity reduces in correlation with using endograft preservation strategies.