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Endovascular aneurysm repair predominates in elective abdominal aortic aneurysm repair because of lower perioperative morbidity and shorter length of stay; however, downstream costs from surveillance, endoleak management, and reinterventions may erode its initial economic advantage over open surgical repair. Key value drivers include risk\u2010aligned screening, standardized surveillance anchored to anatomy and device risk, judicious use of advanced imaging, optimized perioperative pathways, and careful device selection. Savings opportunities include predictive analytics to individualize surveillance, deescalation of routine computed tomography after documented sac shrinkage, smoking cessation, medical optimization, and structured shared decision\u2010making aligned with life expectancy and patient preferences. 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