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Endovascular procedures for aortic aneurysm repair have become widely accepted as safe and effective surgical options. We investigated the efficacy of the multimodality roadmap (MMR) system with biplane fluoroscopy to attempt to reduce the use of contrast medium and exposure to radiation during surgery.We retrospectively reviewed 263 consecutive cases with elective endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR). Patients were categorized into two groups, with and without introduction of the MMR system, which was applied in 164 patients (62.4%). The MMR− group included 62 EVAR and 37 TEVAR cases, and the MMR+ group consisted of 81 EVAR and 83 TEVAR cases. Radiation dose, contrast medium use, and complications were compared between the MMR− and MMR+ groups in the respective EVAR and TEVAR groups.There was a significantly lower amount of contrast medium use in the MMR+ group compared with the MMR− group in EVAR (32.9 ± 10.6 g and 28.2 ± 10.2 g; P = .009) and TEVAR (31.7 ± 11.5 g and 26.9 ± 7.8 g; P = .009). In addition, significantly lower radiation exposure was observed in the MMR+ group of TEVAR (872 ± 623 mGy vs 638 ± 463 mGy; P = .033). The operative time of the MMR+ group was significantly shorter for patients with TEVAR compared with the MMR− group (96.4 ± 27.0 minutes vs 86.2 ± 23.9 minutes; P = .023). The incidence of access injury and other complications was similar in both EVAR and TEVAR groups.The MMR system with three-dimensional fusion imaging can reduce the contrast medium dose in EVAR and the exposure to contrast medium and radiation in TEVAR.