Aortic Aneurysm Repair: Open vs. Endovascular — Cost and ...

Cardiac Surgery · 3 · September 23, 2025

An abdominal aortic aneurysm (AAA) larger than 5.5cm has a 10% annual rupture risk. Rupture is fatal in 80% of cases. Two surgical approaches exist: open surgical repair (replacing the diseased aorta with a Dacron graft) and endovascular aneurysm repair (EVAR — threading a stent-graft through the femoral artery). The 30-day outcomes clearly favor EVAR. The 10-year outcomes tell a more complicated story.

Open Repair: One Surgery, Done

Open AAA repair through a midline laparotomy has been performed since the 1950s. The surgeon clamps the aorta above and below the aneurysm, opens the sac, and sews a Dacron tube graft in place. Hospital stay: 7–10 days. Recovery: 6–12 weeks. Operative mortality: 3–5%. But once healed, the Dacron graft lasts essentially forever — 99% freedom from re-intervention at 20 years. No surveillance imaging needed.

EVAR: Minimally Invasive, But Not Maintenance-Free

EVAR threads a stent-graft (Gore Excluder, Medtronic Endurant, Cook Zenith) through the femoral arteries and deploys it inside the aneurysm. Hospital stay: 1–3 days. Recovery: 2–3 weeks. Operative mortality: 1–2% — significantly lower than open repair. The catch: 25% of EVAR patients need a secondary intervention within 10 years for endoleak (blood flowing around the graft). Annual CT surveillance ($500–$1,000) is required indefinitely.

Total Cost Over 10 Years

EVAR is cheaper upfront ($40,000 vs. $55,000 in the US) but annual surveillance and secondary interventions close the gap. A 2024 JAMA Surgery cost-effectiveness analysis found that open repair was more cost-effective for patients under 70 with a life expectancy over 15 years. EVAR was preferred for patients over 75 or with significant comorbidities. In India, open repair costs $8,000–$12,000 and EVAR costs $15,000–$22,000.

Cost Comparison

| Country | Cost Range (AAA Repair (Open / EVAR))

| United States | $40,000–$80,000

| India | $8,000–$22,000

| Turkey | $15,000–$30,000

| Mexico | $20,000–$40,000

Key Takeaways

- EVAR has lower 30-day mortality (1–2% vs. 3–5%) but 25% need secondary intervention within 10 years.

- Open repair costs more upfront but is maintenance-free — no annual CT surveillance, no endoleak risk.

- Under 70 with good life expectancy? Open repair may be more cost-effective long-term.

Compare real-time pricing using our global cost calculator.