WHAT THIS PAPER ADDS The fenestrated endograft for complex abdominal aortic aneurysm appears as a valuable treatment option in the experience of two tertiary referral centres. Objective: An ageing population leads to more age related diseases, such as complex abdominal aortic aneurysms (AAA). Patients with complex AAAs and multiple comorbidities benefit from fenestrated endovascular aneurysm repair (FEVAR), but for the elderly this benefit is not completely clear. Methods: Between 2001 and 2016 all patients treated for complex AAA by FEVAR at two tertiary referral centres were screened for inclusion. Group 1 consisted of patients aged 80 years and older and group 2 of patients younger than 80 years of age. The groups were compared for peri-operative outcome, as well as patient and re-intervention free survival, and target vessel patency during follow up. Results: Group 1 consisted of 42 patients (median age 82 years; interquartile range [IQR] 81e83 years) and group 2 of 230 patients (median age 72 years; IQR 67e77 years). No differences were seen in pre-operative comorbidities, except for age and renal function. Renal function was 61.4 mL/min/1.73 m 2 vs.74.5 mL/min/ 1.73 m 2 (p < .01). No differences were seen between procedures, except for a slightly longer operation time in group two. Median follow up was 26 and 32 months, respectively. No difference was seen between the groups for estimated cumulative overall survival (p ¼ .08) at one, three, and five years, being 95%, 58%, and 42% for group 1, and 88%, 75%, and 61% for group 2, respectively. There was no difference seen between groups for the estimated cumulative re-intervention free survival (p ¼ .95) at one, three, and five years, being 84%, 84%, and 84% in group 1, respectively, and 88%, 84%, and 82% in group 2, respectively. Ultimately, no difference was seen between groups for the estimated cumulative target vessel patency (p ¼ .56) at one, three, and five years, being 100%, 100%, and 90% for group 1, and 96%, 93% and 92% for group 2, respectively. Conclusion: Age itself is not a reason to withhold FEVAR in the elderly, and choice of treatment should be based on the patient's comorbidities and preferences.