Abdominal aortic aneurysm (AAA) is a prevalent condition encountered in vascular surgery, characterized by a high mortality rate upon rupture, posing a serious threat to patients' lives. The primary treatment options include endovascular aneurysm repair (EVAR) and conventional open repair (OR). With advancements in surgical instruments and techniques, EVAR has gradually become the preferred method. However, EVAR and OR differ significantly in surgical principles and associated complications. EVAR continues to follow surgical indications originally developed for OR, limiting its full realization of its advantages. As clinical evidence continues accumulating, it has become increasingly clear that quantifying and comparing AAA rupture risk and surgical risk through scoring systems significantly aids in developing more rational and individualized treatment strategies.