Open aneurysm repair (OAR) of abdominal aortic aneurysm (AAA) is still an important component of vascular surgery. Notwithstanding refinement of operative techniques and perioperative care, many centers report significant operative mortality rates after elective AAA repair, especially in operative high-risk patients. Therefore, endovascular aneurysm repair (EVAR), initially proposed for patients with excessively high risk for OAR, has now become the primary therapy of elective AAA repair. Although showing high rates of graft-related complications, with more re-interventions, and no benefit of total or aneurysm-related mortalities in the long-term, EVAR is associated with a significantly lower operative mortality than OAR. Many patients are anatomically unfit for EVAR, however newly developed fenestrated or branched stent-grafts have been used in patients with a complex aortic neck. In addition, the use of EVAR has been expanded to the treatment of ruptured or small AAA. With progressive development of endovascular devices and techniques, EVAR will be more properly used in the near future.