Objectives: To compare the long-term outcomes of endovascular repair (EVAR) versus open repair for abdominal aortic aneurysm (AAA). Design: We retrospectively reviewed consecutive AAA patients treated with EVAR (n = 89) or open repair (n = 136) from January 1998 to December 2008. Results: More patients in the open repair group had a longer duration of hospital stay. The operation time was significantly longer in open surgery than in EVAR (p <0.001), and the percentage of patients requiring a transfusion was higher in the open repair group than in EVAR. Patients in the open repair group had a higher incidence of cardiac insufficiency after surgery than did those in the EVAR group. Kaplan-Meier analysis indicated that the proportion of patients without complications in the EVAR group was significantly less than that in the open repair group (68.1% vs. 91.1%; p <0.0001), and the long-term survival rate in EVAR group was similar to open surgery group (87.5% vs. 91.1%; p = 0.555). Thrombosis was found inside of the aneurysm; postoperative complications in the EVAR group included ischemic legs, graft stenosis, and endoleaks that required further endoluminal treatment. Conclusions: Endovascular repair of abdominal aortic aneurysm causes less trauma in patients with AAAs in the short term, and patients treated with EVAR have similar survival rate with open repair in the long term, but have postoperative complications requiring further interventional treatment.