Repair of abdominal aortic aneurysms with endovascular techniques has emerged as the first line of therapy, due to procedural ease and excellent patient outcomes. Open aneurysm repair is increasingly used as a secondary option for lesions with anatomic complexity that involve arterial branches. Understanding the impact of endovascular abdominal aortic aneurysms repair on the shift in vascular operation practice for abdominal aortic aneurysms repair, requires a comprehensive and risk-adjusted review of operative outcomes between the 2 repair types. The American College of Surgeons National Surgical Quality Improvement Project is a comprehensive, outcomes-based program, which provides valuable data on operative complications with endovascular and open repair. In this review, we use the National Surgical Quality Improvement Project database to critically review complications, mortality, and morbidity associated with endovascular and open abdominal aneurysmal repair.