Objective To explore the morbidity and possible mechanism of spinal cord ischemia (SCI) after infrarenal abdominal aortic aneurysm (IAAA) endovascular aneurysm repair (EVAR). Methods We retrospectively analyzed the intra-operative hypogastric artery occlusion and postoperative SCI of 400 patients who received EVAR in the Departments of Vascular and Endovascular Surgery of Shanghai Changhai Hospital and Changzheng Hospital from January 2008 to October 2014. The morbidity and possible mechanism of SCI after EVAR were analyzed while combining the existing literatures. Results Bilateral hypogastric arteries were obstructed during operation in 60 patients (unilateral hypogastric artery aneurysms were embolized by spring coil in 8 cases); unilateral hypogastric arteries was obstructed in 70 patients (unilateral hypogastric artery aneurysms were partially embolized by spring coil in 10 cases). Postoperatively 2 cases had acute lower limb artery ischemia, 1 had acute SCI, and 1 had chronic lower limb lameness(> 3 months). The incidence of SCI was 0.25%(1/400). Existing literatures showed that the incidence of SCI following EVAR was 0.21%-0.38%, and only 1 of the 14 cases with SCI was thought to be associated with the hypogastric artery's interruption. Conclusion SCI is a very rare postoperative complication of EVAR, with the mechanism remaining unknown. The occlusion of hypogastric artery may play a part, but existing literatures suggest a non-core role. In addition to ischemia caused by SCI and embolization, the perioperative general condition of patients also needs to be taken into consideration.