The change in the treatment of abdominal aortic aneurysm (AAA) is the best example of the evolution of vascular surgery from massively invasive to minimally invasive. Since Parodi first reported endovascular aortic repair (EVAR) in 1991, EVAR has evolved rapidly and its effectiveness and minimally invasive nature of treatment has been recognized. At present, the technique has basically matured, and its progress is mainly reflected in the improvement of stent-graft (SG), the improvement of operation techniques, the improvement of postoperative complication management means and the advancement of imaging evaluation techniques. The development of stent-graft has continued to improve with the development of EVAR technology. The combination of alloy stent and ultra-thin overlay has been further optimized, the flexibility of SGs has been improved, and the device introduction system has been further minimized and simplified. By compressing the size of the SG and reducing the diameter of the introduced device, the femoral artery and even the iliac artery can be exposed without surgery, maximizing minimization of invasiveness. The release method has been improved to make the release, positioning and adjustment operations easier. For patients with poor anatomy in the proximal anchorage area (short neck, angulation, large caliber, etc.), or with involvement of visceral artery openings, the “in situ windowing” technique or the use of windowed SGs is used to maintain visceral blood supply. The former technique remains to be studied, while the latter is already available. Initial success has been achieved with open-window SGs for suprarenal, perirenal AAA, and even type IV thoracoabdominal aortic aneurysms, allowing proximal anchorage beyond the level of the renal artery, superior mesenteric artery, and even the abdominal trunk, greatly expanding the indications for EVAR. However, we also need to recognize that: open-window SGs require high preoperative imaging assessment and measurements; at the same time, the technical requirements for operation are greatly improved, and the operator must have both proven experience in EVAR and good skills in endoluminal treatment such as renal artery. The intermediate and long-term complications of this type of SG should also be taken into account, such as displacement, stent dissection, and visceral vessel occlusion. The management of the internal iliac artery is a key component in the management of the distal anchorage zone of EVAR. Given the occlusion of the inferior mesenteric artery in most AAA patients and the need for sometimes artificial embolization, it is generally accepted that at least one side of the internal iliac artery should be preserved. It is particularly important to preserve the internal iliac artery in cases of combined bilateral common iliac artery aneurysms or when one internal iliac artery is already occluded, which may lead to severe gluteal muscle ischemia or even intestinal necrosis if the internal iliac artery is blocked bilaterally. Currently, it has been possible to achieve this by methods such as branching iliac artery type SG or internal iliac artery reconstruction. As mentioned above, the technical success of EVAR requires the selection of appropriate SGs according to different proximal and distal anchorage areas under the premise of good preoperative imaging evaluation. Improvement of surgical steps Previously, intraoperative abdominal aortography was first performed to locate the renal artery, the superior margin of the aneurysm, the bifurcation of the abdominal aorta and the bifurcation of the common iliac artery, and then the superhard guidewire was exchanged and introduced into the SG delivery system. In practice, it was found that the introduction of the superrigid guidewire and the delivery system corrected the distortion of the aneurysm neck, aneurysm body and access artery, and the anatomical position was changed, which required re-profiling, increasing the ray intake, the amount of contrast agent and the operation time. This simplifies the procedure and reduces the radiation intake and the amount of contrast agent. Prevention and management of complications Over time, specific complications such as endoleaks, internal tension, SG displacement, aneurysm rupture, SG fracture or breakage, SG infection, intermittent hip claudication, and aortic enterocutaneous fistula have also started to occur in patients with initial EVAR. These complications have received attention and management tools are becoming more sophisticated. Among these complications, the prevention and management of endoleaks have received particular attention. Since type I and III endoleaks are often the greatest risk factors for postoperative AAA rupture, once detected, they should be promptly managed to correct them by endoluminal means such as balloon dilation, release of cuff or metal bare stent. Given that type I endoleaks are mostly apparatus-related and many are secondary to SG displacement. Open-window SGs can be used, as their suprarenal anchoring and barbed design can effectively reduce the occurrence of migration. In 2003, the Institute of Vascular Surgery, Fudan University, in cooperation with relevant units, developed a functional SG to prevent type I endoleaks and a drug-coated SG to prevent type II endoleaks, both of which have been successfully patented. Broadening of indications for EVAR The indications for EVAR have been broadening, such as ruptured AAA (rAAA), perirenal AAA, pseudoaneurysm, inflammatory aneurysm and infected aneurysm, etc. have been reported. Among them, the endoluminal treatment of rAAA is gaining attention. Compared with the high risk of open surgery for ruptured AAA (mortality 32%-80%), EVAR for rAAA is effective in reducing blood loss, ICU length of stay, early complications, and overall mortality close to 17% (0-40%). Most scholars believe that it is feasible to select appropriate patients for emergency EVAR in the diagnosis and treatment of rAAA. The advent of EVAR in the 1990s has challenged the status of traditional surgical treatment. Today, a large number of clinical reports and evidence-based medical studies, such as the EUROSTAR in Europe, EVAR trail 1 in the UK, and the DREAM trial in the Netherlands, and other multicenter randomized controlled clinical trials, have confirmed that EVAR has a higher perioperative safety than conventional open surgery and is effective in reducing aneurysm-related mortality. For high-risk patients, most scholars also believe that EVAR is a reasonable treatment option. While affirming the feasibility and good near-term efficacy of EVAR, the follow-up results of the above-mentioned trials also point out that the postoperative complication rate and reintervention rate of EVAR are also relatively high compared with open surgery. However, it needs to be recognized that most of the complications of EVAR can still be re-intervened by minimally invasive endoluminal techniques, and it is believed that the indications for EVAR will continue to widen with the continuous improvement of SG and the increasing maturity of operating techniques and perioperative management. The technique was introduced into China in 1997 and quickly became a hot spot in Chinese vascular surgery. Over the past decade, some of the major units that pioneered EVAR, such as Shanghai, Beijing and Guangzhou, have accumulated a large amount of treatment experience, and China is far ahead of the world in terms of the number of EVAR cases. We expect to do our part in the promotion and popularization of the new technology, to refine the technique, improve the apparatus and organize multicenter, prospective and controlled studies in China, Asia and even the world, to establish a training system for endoluminal vascular surgeons and training centers in various regions, to develop recommended norms for the treatment of EVAR, and ultimately to promote the continuous development and improvement of EVAR so that more patients can The goal is to promote the development and improvement of EVAR so that more patients can benefit from it.