E ndovascular repair of abdominal aortic aneurysms (EVAR) has enjoyed a quick and widespread growth over the last 15 years. Both clinicians and patients have embraced the minimal invasive alternative to open surgery. Although early benefits of EVAR have been confirmed in two randomized trials, the number of late complications and re-interventions remains an issue for debate.1, 2) However, the trials failed to demonstrate a late overall survival gain. This opened the way for some epidemiologists and other financial decision makers to question the technique or even worse, to qualify the technique as a failed experiment.3) Despite this, this important surgical innovation has continued to evolve with expansion into the treatment of acute aneurysms and the development of fenestrated and branched grafts. This paper discusses the ongoing evolution of EVAR with respect to the available literature and our personal experience. Elective EvarAs mentioned, the short-term benefits have undoubtedly been demonstrated by two randomized trials. In summary, EVAR presents with a threefold lower mortality than open repair (P = 0.009, EVAR trial) and almost a twofold lower aneurysm related mortality at four years (4% versus 7%, P = 0.04 EVAR trial). In addition, the health related quality of life, often regarded as non-different due to similar results after one year, demonstrated a better outcome from 3 to 12 months.2) Costs were higher in the trial setting, but the difference was marginal, and there are no post-trial comparisons available. The flip side was that the two randomized trials demonstrated a higher late complication rate which resulted in a higher reintervention rate of EVAR compared to open repair.Since the trials, the technique has matured and devices have undergone further development. This has widely resulted in better results especially with regard to durability and reintervention rate. Many reports were published on these changes in outcome with maturation of the technique with the lifeline Registry and Eurostar Registry reporting a decrease in secondary interventions over time. 4,5) With increased experience it is also became clear that Type II endoleaks were not presenting with increased risk of rupture as initially thought. Silverberg et al. reported an incidence of Type II endoleaks of 16% (154/ 946), but 35% of these Type II endoleaks resolved spontaneously during a mean follow-up of 14.5 months.6) A Kaplan Meier analysis suggested spontaneous seal of Type II endoleak of 75% within 5 years. Franks et al. reported in a systematic review a decreasing trend over time in operative mortality, endoleak rate and post-operative rupture. 7)Our personal results show a mortality below 1% which includes all patients, both low-and high risk, and difficult anatomy. The overall reintervention rate dropped from 15% to below 10% with 75% of all reinterventions performed by endovascular means. Furthermore reinterventions were not associated with mortality.