To compare the survival of patients who attended surveillance after endovascular aneurysm repair (EVAR) with those who were non-compliant.MEDLINE and Embase were searched using the Ovid interface.A systematic review was conducted complying with the PRISMA guidelines. Eligible studies compared survival in EVAR surveillance compliant patients versus non-compliant patients. Non-compliance was defined as failure to attend at least one post-EVAR follow-up. The risk of bias was assessed with the Newcastle-Ottawa scale, and the certainty of evidence using the GRADE framework. Primary outcomes were survival and aneurysm-related mortality. Effect measures were the hazard ratio (HR) or odd ratio (OR) and 95% confidence interval (CI) calculated using the inverse variance or Mantel-Haenszel statistical method and random-effects models.Thirteen cohort studies with a total of 22,762 patients were included. Eight studies were deemed high risk of bias. The pooled proportion of patients who were non-compliant with EVAR surveillance was 43% (95% CI 36%-51%). No statistically significant difference was found in the hazard of all-cause mortality (HR 1.04, 95% CI 0.61-1.77), aneurysm-related mortality (HR 1.80, 95% CI 0.85-3.80), or secondary intervention (HR 0.66, 95% CI 0.31-1.41) between patients who had incomplete and complete follow-up after EVAR. The odds of aneurysm rupture were lower in non-compliant patients (OR 0.63, 95% CI 0.39-1.01). The certainty of evidence was very low for all outcomes. Subgroup analysis for patients who had no surveillance versus those with complete surveillance showed no significant difference in all-cause mortality (HR 1.10, 95% CI 0.43-2.80).Patients who were non-compliant with EVAR surveillance had similar survival to those who were compliant. The findings question the value of intense surveillance in all patients post-EVAR and highlight the need for further research on individualized or risk-adjusted surveillance.