Objective To investigate the feasibility and efficacy of therapeutic strategy using modified endovascular aneurysm repair (EVAR) in abdominal aortic aneurysm (AAA) patients with chronic renal insufficiency (CRI). Methods Modified EVAR was performed on AAA 19 patients with CRI, and routine EVAR on 40 cases with normal renal function (control group). The two groups were compared in surgical procedures, outcomes, and complications. GraphPad statistics 8.0 was used for statistical analysis. t test, χ² test or Fisher exact test was performed for data comparison between 2 groups. Results Modified EVAR was successful for all the 19 patients without perioperative death. There was no significant increase of SCr in CRI patients after EVAR (P=0.6109). One patient (5.26%) underwent bilateral renal arterial stenting due to partial coverage of the renal arteries. Slight endoleak (type Ⅱ) were detected in 2 patients (10.53%) without intervention, hematoma/infection puncture site was observed in 1 patient (5.26%), and postoperative fever occurred in 2 patients (10.53%). All patients had no acute renal failure, acute spinal or limb ischemia and other serious perioperative complications. No difference was found in total complications between the two groups. Imageological examinations at 3 months of follow-up showed the stents in all CRI patients in good shape and position with no endoleak, complete thrombosis in the aortic aneurysm cavity, and patency in all branch arteries. During the follow-up period (2 to 28 months, median 15 months), none of the patients except 1 who died of acute myocardial infarction had serious complications such as stent displacement, acute/chronic renal failure or limb ischemia. Conclusion The modified EVAR could protect renal function, reduce the incidence of complication and effectively extend the indications for EVAR in AAA patients with CRI.