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Four randomized clinical trials prospectively compared endovascular (EVAR) and open repair (OR) of abdominal aortic aneurysm (AAA): Chronologically these are EVAR 1 (UK), DREAM (Netherlands), OVER (USA) and ACE (France). All of them investigated whether the superior early postoperative outcome of endovascular repair is maintained in the long-term. The longest follow-up data of EVAR 1, with a mean person-years observation (either until death or end of study) of 8 years, clearly question the superiority of EVAR.

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