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A significant factor in the choice of treatment plan for abdominal aortic aneurysm (AAA) is patient preference. This includes the decision for small AAAs regarding surveillance or early elective surgery and, if surgery is to be performed, which type of surgical repair. Certain factors may limit these options regardless of patient preference, (e.g., presence of risk factors as discussed above). However, in the absence of having a high risk profile, much of the decision rests upon the patient. It is, therefore, very important for the individual with an abdominal aortic aneurysm to be well informed regarding their condition so that they can make appropriate decisions regarding treatment for their AAA.

A patient may prefer to either wait or to proceed with elective surgery for repair of an abdominal aortic aneurysm if the operative risk is low. Studies indicate that early elective surgery does not prolong long-term survival, however, it does impact significantly on the perceived quality of life of patients who felt that they were doing something proactive about their condition. Patients may want to take various considerations under advisement regarding this choice, including:

• Quality of life - some individuals cannot cope with the uncertainty of risk of rupture
• Size of the AAA - since up to 60% or more of patients eventually require surgery, some patients may prefer to undergo elective repair early (e.g., young people with AAAs in the range of 4.5 - 5.5 cm. diameter). Some estimates indicate that approximately 50% of patients for whom the diameter of the aneurysm was 4.5 - 4.9 cm. at the time of diagnosis underwent surgical repair within 5 years and up to 80% of people whose diameter was 5.0 - 5.4 cm. underwent repair.
• Evaluation of the degree of the patient's commitment to ongoing surveillance for expansion of their AAA and the impact of long-term surveillance on the patient's quality of life.

If an individual's risk profile is low and they elect to undergo surgery, the decision of whether to choose open AAA repair or EVAR may be based on considerations of each procedure such as:

• Length of hospital stay
• Recuperation time
• Risk of complications
• Risk of reintervention
• Quality of life after surgery

In comparing responses to a questionnaire regarding quality of life of patients who opted for surveillance of their abdominal aneurysms vs. patients who opted for surgical intervention, some male patients who underwent open AAA repair surgery reported an increased incidence of impotence at 1 year post-surgery but still indicated more of an improved perception of their overall general health for the first few years following surgery than did those patients in the surveillance group. For both groups, quality of life perceptions (e.g., physical functioning, general health, social interactions) declined, but this may also have been related to the fact that the majority of people diagnosed with AAAs are older to begin with and these negative perceptions related to quality of life may reflect the effect of the aging process.