Objective: To compare the perioperative efficacy of endovascular and open repair for AAA by means of systematic review. Methods: The literature of randomized controlled trials (RCTs) comparing endovascular and open repair for AAA was collected by searching the national and international databases. Meta-analysis was performed by using Revman 5.1 software. Results: Seven randomized controlled trials with 8 reports were included, which involved a total of 2?807 patients, of whom 1 433 cases underwent endovascular repair (endovascular group) and 1 374 cases underwent open surgery (open surgery group). Results of Meta-analyses showed that in endovascular group compared with open surgery group, the operative time and volume of intraoperative blood transfusion was reduced (SMD=–0.87, 95% CI=–1.43––0.31, P=0.002; SMD=–0.83, 95% CI=–0.94––0.72, P<0.00001), the length of postoperative stay in ICU and hospital was shortened (MD=–38.11, 95% CI=–48.61––27.61, P<0.00001; MD=–5.11, 95% CI=–6.26––3.95, P<0.00001), and number of 30-day postoperative death was decreased (OR=0.30, 95% CI=0.16–0.55, P=0.0001). Conclusion: Endovascular repair has the perioperative advantages of minimal trauma, reduced blood loss and quick postoperative recovery versus open surgery, but its long term results still need further observation.