Open aortic aneurysm (AAA) repair is an operation performed to prevent aneurysm rupture. It is now performed after consideration of endovascular repair. Open AAA repair is a major operation which involves considerable physiological strain particularly in the elderly. It is therefore important that thorough checks are carried out to identify any co-existing problems so that risk can be quantified and treatment optimised before surgery. Particular attention is paid to the heart, lungs and kidneys. The operation is performed under general anaesthetic. The procedure involves accessing the aortic aneurysm via a midline abdominal incision. The aorta is clamped above and below the aneurysm. The aneurysm is then opened and a graft is sewn to the inside of the aorta above and below the aneurysm. The aneurysm sac is then oversewn. The abdominal incision is closed usually with dissolvable sutures in the skin. Postoperatively patients are initially monitored in intensive care. Here potential complications can be treated. Most patients will return to the ward within 24 hours. The hospital stay may last from 3 days to a week or longer depending on recovery. Open repair offers the advantage over endovascular repair in that further follow up scans are not required and late complications apart from incisional hernia are rare.