Most patients with aortic aneurysmal disease are well served by a routine inline bypass replacement procedure. Excellent results have been reported even in patients with significant medical comorbidities. However, occasionally very high-risk patients may benefit from nonresective aortic aneurysm exclusion treatment in association with an axillobifemoral bypass. In the future, endovascular techniques may supplant most conventional and nonresective techniques, thus allowing operative repair in patients who previously might have been rejected for surgical therapy due to multiple medical comorbidities.