In the last few years, endovascular therapy has become a valid alternative to the traditional surgical treatment of the aneurysmal disease. However, in spite of the existing guidelines, there is still a great degree of variability from one medical center to another vis a vis both the supra-renal and infra-renal aneurysmal disease treatments. Great expectations have grown particularly in the treatment of thoracic and abdominal aneurysms with mixed results. We have certainly seen technological progress that has made it possible to extend the treatment application but many questions still remain. More than ever, greater dialogue between clinicians, engineers and manufacturers is desirable in order to speed up the introduction of new technologies and reduce false hopes in treatments that often do not have a proven long term effectiveness.