OBJECTIVES:To compare the costs of endovascular aneurysm treatment versus open surgery during the perioperative period.METHODS:Retrospective analysis of a consecutive series of 44 patients undergoing infrarenal abdominal aneurysm repair from February 1995 to March 1996 at a university teaching hospital.RESULTS:No endovascular procedure was converted to open repair. Operative time was shorter for endovascular treatment (207.6 min vs. 229.1 min, n.s.), as well as postoperative intensive care unit stay (ICU, 22.7 h vs. 55.0 h, p = 0.017) and the postoperative recovery period (5.6 days vs. 13.3 days, p < 0.001). Open surgery generated significantly more costs (25,374.07 ECU vs. 22,268.78 ECU, p < 0.001), despite evaluation and a more expensive endovascular procedure (10,699.48 ECU vs. 4032.01 ECU, p < 0.001). During the study, costs for open surgery exceeded the cost for endovascular treatment by 13.95%.CONCLUSIONS:Endovascular aneurysm treatment is cost effective and less expensive than open surgery. The main reason for cost saving is faster patient recovery after surgery, associated with a shorter LOS in the patients treated with endovascular procedure.