The treatment of abdominal aortic aneurysms (AAA) has changed significantly since the introduction of endovascular aortic repair (EVAR). In terms of perioperative morbidity and mortality, randomized multicenter trials revealed results in favour of EVAR compared to open reconstruction. However, EVAR is associated with possible late complications caused by endoleaks, stent migration, kinking and/or overstenting of side branches, making life-long follow-up necessary. Since the majority of patients requiring therapy are elderly and exhibit attendant comorbidities, EVAR has become the procedure of choice in those patients with favourable anatomy. Medicamentous and conservative treatment may be relevant in patients with small to medium-sized aneurysms. Since smoking is one of the major risk factors for the development of AAA, all patients should be advised to stop smoking. Studies on long-term statin therapy in patients following surgical AAA repair showed a reduction in both overall and cardiovascular mortality; AAA patients should therefore receive statins for secondary prevention.
