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Abdominal aortic aneurysms (AAA) are managed by two different treatment options, i.e. open graft replacement (OGR) as open surgical technique or endovascular aneurysm repair (EVAR) as minimally invasive procedure, to avoid fatal rupture. The intention of this review was to show how by offering electively either OGR or EVAR - adjusted to the patient's individual risk profile - a benefit for the individual patient could be obtained and overall mortality rates of elective AAA repair could be significantly reduced.A comparative evaluation of both treatment regimes is offered, latest literature as well as own research is presented. Our own risk adjusted patient selection regime is described as well as its statistically significant impact on overall mortality rates in elective AAA exclusion.As conclusion, the benefit of offering both EVAR and OGR is the capability to select and recommend the optimal AAA management for the individual patient with respect to the individual risk profile. The result is a decrease in the overall mortality rate while simultaneously the number of treated patients increases. Furthermore EVAR offers a treatment option for otherwise incurable high risk patients.