Since the first description of abdominal aortic aneurysms by sixteenth-century anatomist Vesalius, the history of this disease has reflected the remarkable progress of vascular surgery. From initial attempts of ligation and sclerosis to the recent advances of endovascular and laparoscopic repair, present-day vascular surgeons are supplied with a technically evolving choice of therapeutics. None of these procedures is mutually exclusive; currently, great interest lies in the use of laparoscopy to provide extraluminal control at the neck of aneurysms, to work with endoluminal grafts, and to control collateral vessel endoleaks. Laparoscopic vascular surgery must not be introduced into the clinical arena based only on the assumption that it is feasible. Clearly, it is a technically challenging procedure with a steep learning curve that requires specialized instrumentation and sophisticated laparoscopic suturing capability; however, with continued investigation, including prospective randomized trials, laparoscopic treatment of aortic aneurysms may become a standard option for high-risk patients.