Abdominal aortic aneurysm is a lethal condition associated with an 85% risk of death after rupture. Optimal treatment relies on early detection followed by prophylactic surgical intervention. Although aneurysms are traditionally treated with open surgery, the use of endovascular repair has increased dramatically and is the most frequent form of therapy in the United States.1 As is often the case with new surgical techniques, there may be trade-offs, including reduced invasiveness, durability, and cost. To weigh these trade-offs, two randomized trials comparing endovascular repair with open surgery have been conducted, the United Kingdom Endovascular Aneurysm Repair 1 (EVAR-1) trial2 and . . .