Things which need to be considered when choosing which surgery is most appropriate include:
1. Fitness of patient for general anesthesia, which is required for the open surgery approach. Patients who are more frail will benefit from the endovascular approach which can be done under local anesthesia.
2. Anatomy of the AAA (some AAAs which involve the arterial branches to the abdominal organs may not be best treated with an endovascular approach).
3. If the AAA is due to connective tissue disorders, an open repair will provide a more durable long-term result without the need for repeat revision surgeries in the future.
There are many more factors to consider and each surgical approach has its pros and cons. It is strongly advised to speak with a Vascular surgeon specializing in both modalities of aortic repair in order to choose the best surgical approach for your particular situation.