Background. Thoracic endovascular aortic repair (TEVAR) has been applied to increasingly complex aortic pathology, resulting in an increase in late complications. We characterized patients undergoing open repair after prior TEVAR including indications, operative techniques, and outcomes. Methods. Chart review and query of a prospectively collected database identified 50 patients who underwent thoracic aortic operation after prior TEVAR. Active follow-up was supplemented by Social Security information for vital status. Results. From July 2001 to January 2012 open arch (n [ 25), descending (n [ 6), thoracoabdominal (n [ 17), or extra-anatomic bypass (n [ 2) operations were performed after previous TEVAR (median interval from TEVAR to open surgical procedure: 13.9 months; interquartile range, 0.5 to 24 months). Indications for open operation included type 1 endoleaks (n [ 19), retrograde aortic dissection (n [ 9), chronic aortic dissection with persistent growth of