Historically, abdominal aortic aneurysm (AAA) rupture carries an approximately 90% overall mortality, and a 40–50% mortality for those patients who reach the hospital alive. Thus, the primary goal of AAA therapy is elective repair to avoid rupture. Although endovascular aortic aneurysm repair (EVAR) has largely supplanted surgical open AAA repair for truly infrarenal aneurysms in recent decades, not all patients are anatomical candidates for EVAR. Some patients are also undergoing open surgery due to perceived issues with durability of EVAR in younger and healthier patients who might live longer. Thus, open techniques are still often utilized in a modern vascular practice, and continued knowledge of how to perform these operations remains important.