Background and Aims Type II endoleak is a common complication after endovascular aortic aneurysm repair (EVAR). However, there is still no agreement on whether surgical intervention is required or the timing of intervention for this condition. Therefore, this study was conducted to evaluate the safety and efficacy of the surgical methods for type II endoleak after EVAR and their efficacy and safety, so as to provide information for clinical decision making.Methods The clinical and follow-up data of patients undergoing EVAR between January 2016 to December 2020 in Department of Vascular Surgery of Xiangya Hospital, Central South University were reviewed. The incidence of type II endoleak after EVAR as well as the efficacy, complications and follow-up results in those undergoing the second surgical intervention were analyzed.Results A total of 282 patients underwent EVAR during the study period. The follow-up was performed for 1 month to 54 months with an average of 17.9 months. During the follow-up, simple type II endoleak occurred in 68 patients (24.1%), in whom, the type II endoleak was spontaneously healed in 31 cases (45.6%), the aneurysmal diameter did not significantly increase in 25 cases (36.8%), and 12 cases (17.6%) underwent a second surgical intervention because the aortic aneurysm diameter increased >10 mm or relevant clinical symptoms were noted. In patients undergoing second surgical intervention, 10 patients underwent percutaneous arterial embolization, of whom 8 cases with embolization of the responsible artery were followed-up for 12 months and had no recurrence of endoleak with reduced aneurysmal diameter, and 2 cases undergoing embolization were follow-up 24 months and the type II endoleak was still visible, but the aneurysmal diameter did not increase; 2 patients underwent open surgery, of whom, 1 case had acute myocardial infarction after surgery, and emergency PCI was performed, and then was uneventfully recovered, and another case had a massive hemorrhage during surgery and the length of hospital was prolonged to 16 d. The 2 patients were followed up after open surgery for more than 6 months, and no further adverse events occurred and the endoleak completely disappeared.Conclusion Most patients with type II endoleak after EVAR have good prognosis. In those with rapid growth of aneurysmal diameter and clinical symptoms, the embolization of the responsible blood vessels can obtain good clinical results. Open surgery is a relatively traumatic procedure, with high incidence of serious complications, so the choice needs to be carefully considered.