Abdominal aortic aneurysm (AAA) carries a rupture-related mortality exceeding 80% when untreated. Percutaneous endovascular aortic aneurysm repair (pEVAR) represents the current technical frontier, although evidence regarding its clinical and economic benefits remains heterogeneous. This narrative review of PubMed, Scopus, and Web of Science from inception to 1 August 2026 synthesises comparative data from 67 publications and four manufacturer websites to evaluate the clinical, quality-of-life, and economic outcomes of pEVAR against open femoral exposure. Current evidence suggests that pEVAR may serve as a feasible alternative to open femoral exposure, offering potential benefits regarding access-site morbidity, hospital length of stay, and early postoperative pain. While RCTs report pEVAR’s early perioperative advantages, evidence regarding long-term safety, anatomy, and costs remains predominantly observational. Additionally, pEVAR allows for locoregional anaesthesia, a strategy hypothesized to positively influence short-term outcomes in ruptured aneurysm emergencies, although prospective validation is required. However, maintaining these benefits relies heavily on overcoming the procedural learning curve and ensuring rigorous pre-procedural patient selection via computed tomography angiography to avoid severe vessel calcification and excessive depth. Available evidence suggests that in carefully selected patients, pEVAR yields an overall safety profile comparable to surgical cutdown, while potentially mitigating the risk of access-site complications.