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Abdominal aortic aneurysm (AAA) represents a major health problem affecting 2%–8% of males over the age of 60 and 1% of women older than 64 years. A lot of patients with AAA remain asymptomatic until the rupture occurs. Early diagnostic and prophylactic surgical intervention (open or endovascular) is essential to prevent rupture. The open repair remains the most durable intervention but the actual approach moves to endovascular aneurysmal repair (EVAR) in most countries. EVAR is nowadays considered the technique of first choice for infrarenal AAAs with suitable aortic anatomy. There are new evolving technologies making endovascular approach suitable to almost all type of aortic morphology as well as acute or chronic pathologies. Patient selection is crucial in the successful treatment of AAA. We should carefully investigate and consider the anatomy of the abdominal aorta but also the comorbidities of the patient when we establish the treatment we propose. Medium and long-term results have improved over the years both in open and endovascular approaches due to better preoperative planning and postoperative management but also to new and refined devices for endovascular treatment.

Endovascular aneurysm repair (EVAR) is an attractive alternative to open surgical approach in treating abdominal aortic aneurysms (AAA). In Nuerenberg in our 14-year experience of 1502 cases (ending December 2007) we used 13 different endografts. The median follow-up was 41 months (1.0-98) and the AAA had a mean diameter of 52.4 mm. Five-hundred and nineteen cases were done using Powerlink grafts. The 30 day mortality was 1.7%. The total reintervention rate was 5.3%, while no distal migration, conversion or post EVAR rupture occurred. At the Army's Center for Cardiovascular Diseases, Bucharest, between July 2008 and December 2009, 15 patients underwent EVAR for AAA. We used the following types of endografts: one Anaconda, three Medtronic Talent, seven Endologix Powerlink and four EVITA Jotec. The mean hospitalization time was three days. Follow-up was done by CT-scan at one, three, six, and 12 months. No endoleaks or infection were seen in the short and medium term follow-up. EVAR is an appropriate treatment for selected patients, especially those at high risk for open surgical repair. The future of EVAR as the potential gold standard for aortic aneurysm therapy rests upon the vision and creativity of both surgeons and technology innovators to realize the potential of endovascular interventions.

Cardiovascular disease is a leading cause of death in all developed countries. In response to this need, endovascular management techniques have been developed across a large range of medical specialties. Minimally invasive percutaneous interventions were initially complex and challenging, but with the continued development of equipment and expertise their use has become routine in many fields. With routine use, it has become important to establish the safety and efficacy of endovascular treatments against the respective "gold standard" procedures, especially in light of their initial intended use for the management of patients at unacceptably high risk for standard therapy only. Such evaluation has to take into account the variety and diversity of devices and techniques, as well as the effects of operator dependability. Endovascular techniques are increasingly recognised as valid alternative management options for a variety of conditions, and it is anticipated that the current trend towards minimally invasive techniques will continue in the future, with moves towards increasingly complex endovascular techniques and hybrid interventions.

Abdominal aortic aneurysms are identified in the elderly population; only a few patients die because of AAA rupture prior to the age of 60. The incidence of the disease in the general population is 60/1000 inhabitants [4] and between 1.8% and 6.6% in autopsies studies. In studies of natural history of AAA the rate of aneurysm rupture and death could exceed 60% within 3 years of the initial diagnosis. [5]