The presence of an abdominal aortic aneurysm remains an under-diagnosed disease associated with a high mortality. Current recommendations are for patients with an aneurysm that exceeds 5.0cm in greatest transverse diameter to undergo repair if they are suitable candidates. Traditional open aneurysm repair is a well accepted technique but can be associated with significant complication rates in higher risk patients. We have employed the endovascular aortic stent graft as a safe method to repair aneurysms in such patients. Suitable patients undergo staging spiral CT scans to accurately determine the size of the aneurysm, the relative position of the renal and iliac arteries, and the geometric relationship of the aneurysm to adjacent vessels. If a patient has suitable anatomy, the stent graft can be employed. The same risk factors evaluated before open repair are assessed before a stent graft repair and include both cardiac and pulmonary system reviews. Patients undergo the percutaneous procedure in generally less than two hours and can then be discharged to home usually within 24-48 hours. Follow-up consists of frequently scheduled CT scans to monitor the graft position in relation to adjacent vessels and, if the patient for migration of the device, measurement of the residual aneurysm volume to document a reduction in size over time, and if needed, angiographic placement of suitable vessel occlusion device to control feeding vessels.