Background: Elective open repair (OR) and endovascular aneurysm repair (EVAR) are the 2 methods of infra-renal abdominal aortic aneurysm (AAA) repair. Each method has advantages and disadvantages. Aim of study was to compare both methods. Patients and methods: Prospective study was conducted at vascular surgery departments, Zagazig University Hospitals, Egypt and Alnoor Specialist Hospital, Makkah, Saudi Arabia from February 2015 to January 2020. Included patients were with asymptomatic AAA with diameter ≥5.5cm or symptomatic. Patients underwent computerized tomographic angiography, echocardiogram, cardiac and chest consultation. Results: 14 patients underwent OR and 9 underwent EVAR. No statistically significant difference between both groups regarding demographics or aneurysm characteristics. In OR group mean age was 65.54±4.44 years and mean aneurysm maximum diameter was 6.92±0.55 cm, while in EVAR group mean age was 67.03±5.31years and mean aneurysm maximum diameter was 7.1±0.3cm. EVAR group had statistically significant less duration of procedure (p<0.001), blood loss (p<0.001), blood transfusions (p=0.003), less ICU (p<0.001) and hospital stays (p<0.001). Conclusion: EVAR group had statistically significant less duration of procedure, blood loss, blood transfusions, ICU and hospital stay than OR group. No statistically significant difference between 2 groups regarding mortality. Second interventions were more in EVAR but did not reach statistical significance. Our study was limited by small number of patients and only 2 years follow-up. However, there is an evolving concept in literature that in low-risk patients, both procedures have nearly similar results with less reinterventions in OR, but for high risk patients EVAR may be preferred. So, selection between EVAR and OR should be tailored for each patient according to surgical risk, life span, aneurysm anatomy and patient choice