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Objectives: To define outcomes and complications after open repair (OR) and endovascular repairs (EVAR) of AAAs during the past 25 years. Methods: Clinical data of consecutive patients with AAAs treated over a 25-year period between 1987 and 2011 in one surgical service were retrospectively reviewed. Primary endpoints were mortality and complications, reinterventions and late ruptures. SVS comorbidity scores stratified patients into low risk (score ≤10) or high-risk category (score >10). Chi-square test, Kaplan-Meier method with log-rank tests and Cox Proportional Hazards regression were used for analysis. Results: 915 patients, 140 females, 775 males, mean age 73 years (range: 9-94 years) were studied. 790 patients (86%) were asymptomatic, 41(5%) had symptomatic and 84 (9%) had ruptured AAA. OR was performed in 721 (79%) patients, EVAR in 194(21%). Early mortality was 2.21% (14/635) for elective, 5.26% (2/38) for symptomatic and 32.39% (23/71) for ruptured aneurysm (P<0.0001). Forty-two patients with elective OR underwent concomitant renal or visceral revascularization. Mortality and Survival for Elective Patients with AAA Repair OR (n=606) EVAR (n=182) 30-day % 10-year** % 30-day % 10-year** % Overall 3.43 61.80 0.55 65.79 High risk 4.2 77.36 1.61 84.29 Low risk 1.69* 55.20* 0? 57.84? OR with visceral/renal reconstruction (n=42) 3.12 68.52 OR without visceral/renal reconstruction (n=562) 2.4 61.19 *: P><0.05 compared to high risk in OR, ?: P><0.05 compared to high risk in EVAR; ** survival For elective, symptomatic and ruptured aneurysms, the 30-day morbidity rates were 17% (111/635), 34% (13/38) and 52% (37/71) (P><0.0001); the 10-year survival rates were 38%, 28% and 19% (P><0.01); the 10-year freedom from complication rates were 73%, 62% and 47% (P><0.0001); the 10-year freedom from reintervention rates were 80%, 75% and 72% (P=0.02). There were four ruptures after elective repair, one after OR and three after EVAR. Ruptured AAA was associated with early and late all-cause mortality, morbidity and reintervention (P><0.05). Conclusions: Clinical presentation affects the outcomes at 10 years after AAA repair and ruptured aneurysms are associated with higher mortality, morbidity and reintervention. Elective repair with OR or EVAR in low risk patients has a significantly lower mortality and better long term survival than in high risk patients.