Endovascular aneurysm repair (EVAR) has undergone a tremendous evolution in the nearly 15 years since it was first described. Continual refinement of the technology and techniques associated with EVAR and the respectable short-term results of this procedure led the United States Food and Drug Administration to approve several devices for the endovascular treatment of abdominal aortic aneurysm (AAA). There has been a corresponding rapid dissemination of this technology throughout the vascular surgery community in the United States. Availability and critical analysis of mid- and long-term follow-up data on the increasing number of patients who have undergone EVAR has begun to raise questions about the long-term durability and effectiveness of EVAR. Numerous complications of EVAR are now recognized and well described in the literature. One of these is graft limb dysfunction. Graft limb occlusion occurs in a significant number of patients and it is imperative that physicians who perform EVAR have a thorough understanding of this condition. There are a variety of factors that predispose patients to development of graft limb occlusion. These factors can be classified as either anatomic or graft-related. When patients present with graft limb occlusion, endovascular treatment is usually possible and it is highly effective. Some cases require traditional surgical treatment. Prevention of graft limb occlusion is of paramount importance. It can only be achieved with an aggressive search for graft limb compromise and liberal use of angioplasty and/or stenting at the time of graft implantation.