The aim of this study was to analyse and compare the outcome of open surgery (OS) and endovascular repair (ER) for the treatment of visceral artery aneurysms (VAA). A systematic literature search was carried out. 25 comparative cohort studies with 4447 patients (2469 OS and 1978 ER) were included in the meta-analysis. Mortality (ER vs OS 1.8% vs 2.1%, OR .77, 95% CI [.51; 1.17], P = .23) and technical success rates (97% vs 98%, OR .50, 95% CI [.21; 1.16], P = .11) were comparable between both groups. Lower mortality rates for ER were observed for ruptured aneurysms (4.1% vs 31%, OR .43 95% CI [.13; 1.43], P = .17). Length of stay was shorter (mean difference −4.25 days, 95% CI [−5.52; −2.98], P < .00001) and 1-year reintervention rates were higher in the ER group (9% vs 5%, OR 1.55 95% CI [.58; 4.12], P = .38. The presented evidence suggests that ER should be considered a first-line treatment for VAAs, especially in an emergency setting, due to lower morbidity and comparable mortality and technical success. Follow-up should be offered to these patients due to the higher reintervention rates. Systematic review registration PROSPERO ID 348699