Abdominal aortic repair may be required for atherosclerotic occlusive disease or aneurysmal dilation of the aorta. Aorto-occlusive disease usually presents as claudication. An abdominal aortic aneurysm (AAA) may be found incidentally. Alternatively, it may present with back pain or, if ruptured, severe shock. Ninety-five percent of all AAAs occur below the level of the renal arteries. Indications for repair are largest diameter greater than 5.5 cm in men and 5.2 cm in women; rate of expansion exceeding 1 cm/year; or symptoms secondary to the AAA. The annual risk of rupture of an expanding 5-cm aneurysm is about 4%. The operative mortality for elective AAA repair is less than 2%, while the overall mortality of aneurysm rupture is 70% to 80%.