Väärämäki S, et al. - Researchers sought to describe the outcome of patients treated for abdominal aortic aneurysm (AAA) with a first-generation stent graft, Vanguard (Boston Scientific, Natick, Mass), in a single academic center with a follow-up of up to 20 years. Between February 1997 and November 1999, 48 AAA patients [mean age: 70 years (range, 54-85 years)] were provided elective treatment with a Vanguard stent graft. The mean follow-up was 107 months (range, 6-262 months). Multiple graft-related complications occurred in 90% of the patients in correlation with using the Vanguard. The most commonly encountered complications were endoleaks (type I, 27%; type II, 29%; type III, 31%), stent fracture (46%), graft thrombosis (31%), and migration (40%). Treatment of these complications mainly involved endovascular means. At 1 year, 5 years, 10 years, 15 years, and 20 years, the cumulative overall survival rates of 94%, 69%, 33%, 15%, and 13%, respectively, were observed. The Vanguard stent graft is thus suggested as a good example of how new technology can result in unpredictable problems that can increase the workload and threaten the patient's well-being even decades after the initial procedure.