Our data suggest that at a maximum follow-up of 7 years, patients who undergo EVAR show lower perioperative and late aneurysm-related mortality compared with a younger and substantially healthier group of patients with aneurysms treated with open repair. The higher need for secondary procedures in the endovascular group did not affect superiority of the overall performance of EVAR in the early and late intervals.

The risk of death after early conversion should be recognized, to avoid forcing morphological indications for primary EVAR. Occurrence of late conversion after EVAR is not negligible, affecting almost 1 out of 10 patients after 6 years. In the presence of an expanding aneurysm after EVAR, especially after a failed secondary endovascular correction, an aggressive attitude in fit patients allows outcomes at similar to those of primary OR.

HighlightsThe association of unstable spinal fractures and pending aortic injuries is a therapeutic dilemma.Inappropriate treatment can lead to catastrophic consequences.A multidisciplinary, case-by-case evaluation is mandatory.Vascular lesions must be treated first.We suggest “best but safest” procedure sequence: endovascular aortic repair and then posterior spinal cord reconstruction.

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