OBJECTIVES: Canadian hospitals spend an estimated $111 million annually on elective AAA repair. Percutaneous endovascular abdominal aortic repair approach (PEVAR) is a minimally invasive technique that avoids surgical cut down associated with standard endovascular AAA repair (EVAR). Innovations in access devices and low profile stent grafts have enabled the PEVAR approach. According to recent studies, PEVAR may offer substantial efficiency benefits as well as a reduction in post-operative complications and patient pain. The objective of our study was to evaluate the budget impact to a hospital of changing the technique for AAA repair from the EVAR approach to the PEVAR approach. METHODS: We examined the budget impact of replacing the EVAR approach with the PEVAR approach in a Canadian hospital that performs 100 endovascular AAA repairs annually. The model incorporates the costs associated with surgery, length of stay and postoperative complications occurring within 30 days. The cost data used in the model was obtained from peer reviewed literature, the Ontario Case Costing Initiative and case costing from a large Canadian hospital.  Patient outcomes data was obtained from pooling published prospective studies after completing a comprehensive literature review. A multivariate sensitivity analysis was completed. RESULTS: The use of PEVAR in AAA repair is associated with increased access device costs when compared to the EVAR approach. However, AAA repair completed with the PEVAR approach demonstrate reduced operating time, a reduction in length of stay and time in the recovery room and a reduction in post-operative complications which offset the increased device costs. The model establishes that switching to the PEVAR approach in a Canadian hospital performing 100 AAA repairs annually would result in a potential cost avoidance of $245,120. CONCLUSIONS: A change in AAA repair technique from EVAR to PEVAR can be a cost-effective solution for Canadian hospitals.