Advancements in the medical science have significantly increased patient longevity and it is safe to assume that vascular care is becoming more complex with time. Managing patients will require thoughtful planning and the use of minimally invasive techniques to prevent complications and death. This is particularly true when managing patients with complex aortic aneurysms and dissections who have multiple comorbidities and need difficult aortic reconstructions involving side branches. The fast pace of evolving endovascular technology has changed the paradigm from open surgical repair to widespread use of stent-grafts. These novel developments expanded the indications of endovascular procedures to treat aneurysms involving the arch, thoracoabdominal, and iliac arteries. A new set of skills is needed to perform these operations. Dedicated training programs are already available in the form of workshops, mini-fellowships, or a formal endovascular aortic training. In most successful programs, one or more leading physicians with prior dedicated training formed aortic teams to overcome the learning curve that is needed to master these procedures. This chapter summarizes novel training paradigms, credentialing, learning curve, and factors affecting failure to rescue after complex endovascular procedures.