Purpose of Review <p>To summarize recent data comparing endovascular and open repair of infrarenal abdominal aortic aneurysms, with emphasis on long-term durability and patient-centered decision-making.</p> Recent Findings <p>Randomized controlled trials and real-world studies show that while endovascular repair offers lower perioperative risk, its long-term survival benefit erodes over time, with higher rates of reintervention and aneurysm-related mortality. Adherence to device instructions for use improves durability. However, the benefits of long-term surveillance and reintervention remain unclear. Shared decision-making and emerging decision aids can help align treatment with patient values.</p> Summary <p>Choosing repair type requires balancing early procedural risk with long-term outcomes. Individualized, preference-sensitive care is critical, especially as technologies evolve and long-term follow-up remains a challenge.</p>