Today, endovascular therapy is the recommended treatment modality for most aortic aneurysms and open surgery remains an essential treatment method for many patients. Long-term results obtained with endovascular therapy suggest that younger patients with a reasonably long life expectancy and low perioperative risk may benefit from open repair. Therefore, it is necessary to know both techniques for a comprehensive practice of aortic aneurysm surgery. A variable rate of RSO-related complications has been observed across studies. These complications, in order of appearance, are pulmonary (42%), cardiac (18%), renal (17%), ischemic colitis (9%), and wound complications (7%). Other less common but serious complications are postoperative end-organ ischemia, including colonic ischemia, acute lower extremity ischemia, or spinal ischemia. Historically, studies have shown that the benefit of EVAR in the early years decreases or could even be lost over time and therefore, EVAR could lead to a higher risk of rupture and reinterventions compared to open repair (OR) long-term. Under these considerations, the OR of AAA remains very important and should not be neglected in the endovascular era. The following chapter will show the strategy to develop an adequate selection of patients to undergo AAA, indications and contraindications.