Which is better in the long run?

Long-term survival is similar with both methods, but EVAR needs continued surveillance and may require more additional procedures.

Can EVAR be converted to open surgery later?

Yes, in rare cases when the graft fails and cannot be fixed with a catheter procedure.

Is age the deciding factor?

Age matters, but it is not the only factor; overall health and arterial anatomy are equally important.

EVAR or Open Surgery? Choosing the Right Repair for Abdominal Aortic Aneurysm

What is open repair?

In open surgery the abdomen is opened, blood flow in the aorta is temporarily stopped, and the aneurysmal segment is replaced with a synthetic tube graft sewn into the artery. It is a long-established operation with excellent long-term results and needs less imaging follow-up once recovery is complete.

Quick comparison

Incision: EVAR uses a needle puncture or small groin incision; open repair needs an abdominal incision.
Hospital stay: 1–3 days after EVAR versus about a week after open repair.
Full recovery: around two weeks after EVAR versus 6–12 weeks after open surgery.
Early risk: lower with EVAR in the first months.
Follow-up: EVAR needs lifelong imaging and has a somewhat higher chance of a secondary procedure in the long term.

When do we prefer EVAR?

Older patients and those with heart or lung disease that increases the risk of major surgery.
When the aneurysm neck and iliac arteries are anatomically suitable.
In ruptured aneurysms when anatomy allows, because it places less stress on the body in an emergency.

When do we prefer open surgery?

Younger, fit patients with a long life expectancy.
Anatomy unsuitable for a stent-graft (very short or angulated neck, narrow access arteries).
Patients unable to commit to regular imaging follow-up.
Some cases of infection or connective tissue disease.

How is the decision made?

The decision follows a detailed CT scan of the aorta and a full assessment of heart, lung and kidney function, then an open discussion with the patient and family about the benefits and risks of each option. With modern fenestrated and branched grafts, many complex cases can now also be treated endovascularly.