By definition, an infrarenal abdominal aortic aneurysm (AAA) is located in the distal portion of the abdominal aorta, inferior to the renal arteries. The segment of aorta between the renal arteries and an infrarenal aneurysm is commonly referred to as the “neck” of the aneurysm. The anatomic characteristics of this area are of critical importance when considering therapeutic strategies for both open and endoluminal interventions. Prior to the endovascular era, optimal management of coexistent aortic aneurysmal disease and visceral pathology was somewhat controversial. While some centers advocated open endarterectomy for stenotic ostial lesions of the renal and visceral vessels at the time of aneurysm repair, others preferred reimplantation or bypass for similar lesions. The choice of intervention was often individualized and based somewhat upon surgeon preference. With the advent and the widespread uptake and utilization of endovascular techniques, it is readily evident that many infrarenal and thoracoabdominal (TAAA) aortic aneurysms can be repaired using intraluminal stent-graft devices. Furthermore, the successful deployment of fenestrated or branched stent-graft devices has expanded the limits of endoluminal aneurysm repair. Currently, the treatment of juxtarenal, suprarenal, and TAAA may be performed solely via an endovascular approach. In the United States, complex endovascular aortic repairs can be performed in a center under physician-sponsored investigational device exemption (PS-IDE) clinical trials. Optimal management of aortic aneurysm and coexisting arterial branch-vessel occlusive disease is predicated on a thorough knowledge of the anatomy, pathophysiology, clinical picture, natural history, and therapeutic options that are available for each of the underlying disease processes. A logical platform from which to commence evaluating these processes is to review the current understanding of stenotic lesions affecting the renal arteries, superior mesenteric artery, and the celiac artery.