AbstractSince its introduction 2 decades ago, endovascular repair of abdominal aortic aneurysms has continued to evolve, and many now consider it the optimal treatment modality for infrarenal abdominal aortic aneurysms. There are currently 5 commercially approved endografts, each with its unique design, and all can be utilized with excellent technical results. The endovascular repair is performed with radiographic guidance utilizing general, spinal, or local anesthesia. Endoleak is the most common complication and unique to the procedure. Routine postoperative surveillance imaging is essential to ensure long‐term success. Clinical trials have demonstrated lower perioperative mortality and morbidity for endovascular repair of abdominal aortic aneurysms compared with open repair. However, evidence for long‐term survival benefits is lacking. Furthermore, the benefits of endovascular repair in “high‐risk” patients remain unclear. Though there is a subset of patients who benefit from endovascular repair of abdominal aortic aneurysms, objective identification of this population remains a challenge. Practitioners currently recommend elective repair for aneurysms ≥ 5.5 cm in diameter and in selected patients with smaller aneurysms. Current studies are underway to evaluate the utility of endovascular repair in small aneurysms. Patients with ruptured aneurysms, due to the high morbidity and mortality associated with their management, may significantly benefit from endovascular repair. Although there is a lack of sufficient randomized controlled trial data, available evidence does support the use of endovascular repair for ruptured abdominal aortic aneurysms. Multiple newer endovascular devices are under clinical investigation to address the limitations of available devices. Ultimately, we may be able to treat the vast majority of patients with all types of abdominal and thoracoabdominal aortic aneurysms with endovascular devices. Mt Sinai J Med 77:238–249, 2010. © 2010 Mount Sinai School of Medicine