“BACKGROUND: Whether elective endovascular repair of abdominal aortic aneurysm reduces long-term morbidity and mortality, as compared with traditional open repair, remains uncertain.METHODS: We randomly assigned 881 patients with asymptomatic abdominal aortic aneurysms who were candidates for both procedures to either endovascular repair (444) or open repair (437) and followed them for up to 9 years (mean, 5.2). Patients were selected from 42 Veterans Affairs medical centers and were 49 years of age or older at the time of registration.”
Long-term comparison of endovascular and open repair of abdominal aortic aneurysm.
Lederle FA et al. 
N Engl J Med. 2012 Nov 22;367(21):1988-97

“Endovascular repair and open repair resulted in similar long-term survival. The perioperative survival advantage with endovascular repair was sustained for several years, but rupture after repair remained a concern. Endovascular repair led to increased long-term survival among younger patients but not among older patients, for whom a greater benefit from the endovascular approach had been expected.”
Long-term comparison of endovascular and open repair of abdominal aortic aneurysm.
Lederle FA et al. 
N Engl J Med. 2012 Nov 22;367(21):1988-97

“Our results suggest that endovascular repair continues to improve and is now an acceptable alternative to open repair even when judged in terms of long-term survival. However, our results also indicate that late rupture remains a concern and that endovascular repair does not yet offer a long-term advantage over open repair, particularly among older patients, for whom such an advantage was originally expected.”
Long-term comparison of endovascular and open repair of abdominal aortic aneurysm.
Lederle FA et al.
N Engl J Med. 2012 Nov 22;367(21):1988-97

“ The overall use of EVAR has risen sharply in the past 10 years (5.2% to 74% of the total number of AAA repairs) even though the total number of AAAs remains stable at 45,000 cases per year. In-hospital mortality rates for both ruptured and unruptured cases have fallen by more than 50% during this time period. Lower mortality rates and shorter LOS despite a 27%-36% higher cost of care continues to justify the use of EVAR over OAR. For patients with suitable anatomy, EVAR should be the preferred management of both ruptured and unruptured AAAs.”
Epidemiology of aortic aneurysm repair in the United States from 2000 to 2010 
Dua A et al.
J Vasc Surg 2014;59:1512-7

“In this observational study, a total of 23 670 patients were studied, with 52% receiving EVAR. Endovascular repair was associated with improved 30-day outcomes (all-cause mortality, readmission, surgical site infection, pneumonia, and sepsis), as well as significantly improved survival until 3 years postoperatively. After 3 years, mortality was higher for patients who underwent an EVAR repair. No significant difference in long-term mortality was observed for the entire cohort on adjusted analysis (hazard ratio, 0.99; 95% CI, 0.94-1.04; P = .64). Endovascular repair was found to be associated with a significantly higher rate of reinterventions and AAA late ruptures.”
Survival After Endovascular vs Open Aortic Aneurysm Repairs.
Chang DC, Parina RP, Wilson SE
JAMA Surg. 2015 Sep 2:1-7.

“The survival advantage for EVAR repair in a statewide population is maintained for 3 years. After 3 years, EVAR repair was associated with higher mortality; however, these mortality differences did not reach statistical significance over the entire study period. Reintervention and late AAA rupture rates are higher after EVAR repair.”
Survival After Endovascular vs Open Aortic Aneurysm Repairs.
Chang DC, Parina RP, Wilson SE
JAMA Surg. 2015 Sep 2:1-7.

“During 12 years of follow-up, there was no survival difference between patients who underwent open or endovascular abdominal aortic aneurysm repair, despite a continuously increasing number of reinterventions in the endovascular repair group. Endograft durability and the need for continued endograft surveillance remain key issues.”
Long-term survival and secondary procedures after open or endovascular repair of abdominalaortic aneurysms.
van Schaik TG at al.
J Vasc Surg. 2017 Nov;66(5):1379-1389

“Despite treating patients with high preoperative risk status, we report a 10-fold decrease in operative mortality for EVAR and open AAA repair in a tertiary vascular center compared with national Medicare-derived predictions. High-risk patients should be considered for aneurysm management in dedicated aortic centers, regardless of approach.”
Mortality variability after endovascular versus open abdominal aortic aneurysm repair in a large tertiary vascular center using a Medicare-derived risk prediction model.
Hicks CW , Black JH 3rd, Arhuidese I et al.
J Vasc Surg. 2015 Feb;61(2):291-7

“Type II endoleak is the most common endoleak. It is seen in 10% to 20% of patients at the completion of EVARs. The usual culprit is retrograde filling of an aneurysm sac by either a patent IMA or a lumbar artery. Fortunately, spontaneous resolution is noted in up to 50% to 60% of patients by 30 days.”
Overview of aortic aneurysm management in the endovascular era.
Calero A, Illig KA.
Semin Vasc Surg. 2016 Mar;29(1-2):3-17

 Type IV endoleak refers to the diffuse contrast blush occasionally seen immediately after implantation. This is a reflection of porosity of graft material and is usually self-limited and does not require treatment.