Open treatment versus endovascular repair for aortic abdominal aneurysm-keeping the balance.

Endovascular repair of abdominal aortic aneurysms (EVAR) has enjoyed a quick and widespread growth over the last 15 years. Both clinicians and patients have embraced the minimal invasive alternative to open surgery. Although early benefits of EVAR have been confirmed in two randomized trials, the number of late complications and re-interventions remains an issue for debate. 1, 2) However, the trials failed to demonstrate a late overall survival gain. This opened the way for some epidemiologists and other financial decision makers to question the technique or even worse, to qualify the technique as a failed experiment.3) Despite this, this important surgical innovation has continued to evolve with expansion into the treatment of acute aneurysms and the development of fenestrated and branched grafts. This paper discusses the ongoing evolution of EVAR with respect to the available literature and our personal experience.