Introduction - Late open conversions (LOC) after EVAR are associated with a considerably increased perioperative morbidity and mortality as compared to standard EVAR or open repair. Additionally, since the number of patients undergoing EVAR is increasing, the incidence of LOC performed for ruptured aneurysms or infected endografts will likely rise in the future. Here we report a multicentre experience of urgent LOC, with the goal of identifying technical aspects and outcomes that may alter clinical management. Methods - A retrospective analysis of EVAR requiring urgent LOC (>30 days after implantation) from 1996 to 2016 in six Vascular Centres was performed. Specifically, patients who presented with aneurysm rupture or other conditions (such as graft thrombosis, infection or aneurysm growth associated with pain) which required urgent surgery (<24h) were selectively included. Patients' demographics, duration of implant, type of endograft, previous attempts of endovascular correction, reason for LOC, operative technique (clamping site, partial or complete graft removal), 30-day mortality and post-operative complications were obtained for analysis. Long-term survival was also evaluated. Results - During the study period, 140 patients underwent LOC in the participant institutions. Among these, 42 were operated in a urgent setting and were therefore analyzed. Mean age at conversion was 75.8±9 years; 88.1% were male. Grafts were excised after a median of 37 months (range: 1.6-132.1). Multiple types of endografts have been explanted: 30/42 bifurcated endografts, 5/42 tubes, 5/42 aorto-uni-iliac and 2/42 iliac side-branch devices. A suprarenal fixation was present in the 66.7% of the endografts. Eleven patients (26.2%) underwent endovascular reintervention for endoleak repair prior to LOC. Indications for urgent LOC were: aneurysm rupture in 24/42 cases (57.1%), endograft infection in 10/42 (23.8%), endoleaks associated with aneurysm growth and pain in 6/42 (14.3%) and recurrent endograft thrombosis in 2/42 (4.8%). Proximal aortic cross-clamping site was infrarenal in 38.1% of the cases, suprarenal in 19% and supraceliac in 42.9%. Complete removal of the stent-graft was performed in 32 patients (72.6%), partial removal in the remaining 10 cases (with preservation of the proximal portion in 7/10 cases). Reconstructions were performed with dacron grafts in 33/42 cases, cryopreserved arterial allografts in 5/42 and endograft removal associated with prosthetic axillo-bi-femoral bypass in 4/42. Overall 30-day mortality was 21.4%. A suprarenal clamping site was associated with a statistically significant higher mortality rate of 34.6% (p=.007). During follow-up, we experienced 1 aneurysm-related death due to the rupture of an aortic stump. The estimated 1- and 5-year survival rates were 62% and 46%, respectively. Conclusion - Urgent LOC after EVAR are associated with high postoperative mortality rates and poor long-term survival. The need of a suprarenal clamping is associated with worse outcomes. A close follow-up after EVAR is mandatory, since early decision for elective LOC may improve postoperative outcomes in this subgroup of patients. Further studies are eagerly awaited to better define the timing and the best treatment option for failing EVAR, since a standardization of the surgical technique may improve patients' survival.