Endovascular treatment of aneurysms is an evolving technique. Endovascular techniques for the treatment of aneurysms have been available for 10 years. During this time, we have seen major advances and improvements in our ability to embolize aneurysms via an endoluminal approach. We have continued to modify our techniques and selection of patients who would most benefit from this approach. This article summarizes the current literature and attempts to develop a management strategy toward improving patient outcome by optimizing the choice between endovascular and surgical treatment modalities.