Sex differences in endovascular abdominal aortic aneurysm repair (EVAR) outcomes have been increasingly reported, although the factors influencing this disparity are not well-defined. We investigated the sex differences for elective EVAR outcomes at our institution and evaluated the factors potentially predisposing women to increased morbidity and mortality. A retrospective medical record review of all patients who had undergone elective EVAR from 2011 to 2016 at a suburban tertiary care center was performed. The primary outcomes were survival and freedom from reintervention at 1 and 5 years postoperatively. The secondary outcomes included the postoperative intensive care unit stay and 30-day readmission rate. The Fisher exact test, t test, and Kaplan-Meier analysis using the rank-log test were used to investigate the associations between sex and outcomes. A multivariate Cox proportional hazard model was used to evaluate the effect of sex on survival and freedom from reintervention. A total of 185 patients had undergone elective EVAR, including 46 women (25%) and 139 men (75%). On average, the women were older than were the men (76 years vs 73 years; P = .04) and were more likely to have chronic obstructive pulmonary disease (41% vs 21%; P = .01) and to require home oxygen therapy (11% vs 3%; P = .04). Other common vascular comorbidities were distributed similarly between the sexes. The intensive care unit level of postoperative care (13% vs 5%; P = .09) and 30-day readmission rate (20% vs 9%; P = .06) showed a trend toward a greater incidence in the women. Survival was similar between the men and women at 1 year (95% vs 91%; P = .34) and 5 years (67% vs 55%; P = .12). The freedom from reintervention rate was significantly lower for the women than for the men at 1 year (96% vs 86%; P = .02) and 5 years (86% vs 69%; P < .03; Fig). Although female sex did not significantly predict for 5-year survival (hazard ratio, 1.4; 95% confidence interval, 0.8-2.6; P = .26) on multivariate analysis controlling for age and common comorbidities, female sex persisted as the only significant outcome predictor among the covariates using a similar analysis for 5-year freedom from reintervention (hazard ratio, 2.8; 95% confidence interval, 1.2-6.6; P = .02). Female sex was independently associated with 1- and 5-year reintervention, but not survival, after controlling for age and comorbidities. These findings suggest that sex-specific factors, in addition to age at presentation and baseline health risk, contribute to greater surgical morbidity for women after elective EVAR.