Abstract
Open repair, endovascular repair (EVAR) and optimal medical therapy each have a role to play in the management of abdominal aortic aneurysms (AAAs); however, the latter has proven to be ineffective in preventing the expansion and rupture of AAAs. The benefits of EVAR over open repair of AAAs have been repeatedly demonstrated in the shortto medium-term and, as a result, EVAR is the treatment of choice in most vascular centers. In 2006, the number of EVAR procedures performed in the USA exceeded that of open repair and this paradigm shift toward EVAR continues. However, despite global dissemination of endovascular technology, unproven benefits continue to cause controversy, such as long-term durability, surveillance, emergency repair, the use of endografts outside of the instructions for use (IFU), costs, patient age and screening. These unresolved issues will strongly influence technical developments and future configuration of vascular services.
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