Purpose: To evaluate the durability, need for secondary procedures, and associated long-term morbidity of endovascular aneurysm repair (EVAR) compared to open repair procedures in patients with abdominal aortic aneurysm (AAA). Method: A retrospective study was performed in 1,005 patients who underwent EVAR and in 903 patients who underwent open repair between 1985 and 2009. Health system charts and medical correspondences were reviewed to obtain information related to durability, secondary procedures, and comorbidities. Secondary interventions included vascular (aortic graft or remote) and nonvascular (incisional or gastrointestinal) procedures. Results: Patients (n≤1,908) had a mean age of 70 years, 16% were women, and 10% were nonwhite. During over 12 years of total follow-up, secondary procedures occurred in 23% (230 of 1,005) patients after EVAR and 22% (194 of 903) patients after open repair (odds ratio [OR], when EVAR was compared with open repair, 1.08; 95% confidence interval [CI], 0.87-1.34; P≤.495). Secondary vascular procedures occurred in 22% (221 of 1,005) patients after EVAR and 13% (114 of 903) patients after open repair (OR, 1.95; 95% CI, 1.52-2.50; P<.001). Secondary nonvascular procedures occurred among 0.9% (9 of 1,005) patients after EVAR and 9% (80 of 903) patients after open repair (OR, 0.09; 95% CI, 0.05-0.19; P<.001). Conclusions: EVAR is associated with higher risk of secondary vascular procedures whereas open AAA repair is associated with higher risk of late secondary nonvascular procedures. Further prospective multicenter long-term studies may be required to reproduce these associations as well as identify factors that may help reduce secondary procedures.