Rupture of an abdominal aortic aneurysm (AAA) remains a common vascular catastrophe in all emergency departments. Currently, the natural history of AAAs indicates that risk of rupture increases considerably when the aneurysm is greater than 5 cm in diameter. Appropriate management of aneurysms is elective repair for patients with a good operative risk whose aneurysm is between 5 and 6 cm. For patients with a serious medical comorbidity, the threshold for AAA repair is usually 6 cm. Surgical management is generally safe with extraordinarily durable results. Another current option is an investigational endovascular stent graft, but the long-term outcome for these new devices remains unknown. In addition, optimal medical management should include careful control of hypertension and smoking cessation. The current prognosis for healthy patients who undergo elective aneurysm repair is excellent.