Improvements in the operative mortality and morbidity rates in elective aortic replacement, which are largely a result of refinements in surgical technique and perioperative management, have allowed a more aggressive approach in the treatment of abdominal aortic aneurysm (AAA) in elderly patients. To evaluate this approach, we reviewed the records of 116 patients 80 years of age and older (range: 80 to 93 years) who consecutively underwent aortic replacement for AAA. Seventy-seven patients underwent elective aortic replacement with 8 complications and a 3% operative mortality rate (2 of 77). Emergent aortic replacement was performed in 39 patients (14 with symptomatic nonruptured AAA and 25 with ruptured AAA) with 12 complications. In this nonselective subset, there were eight deaths, for an operative mortality rate of 20% (symptomatic 14%, ruptured 24%). In comparison, 780 patients less than 80 years of age underwent aortic replacement during the same time period. Within this group, 622 patients who were treated on an elective basis had a similar operative mortality (2%) as did patients 80 years of age and older. On the basis of these results, we believe that elective aortic replacement in elderly patients is justified and can be achieved with low operative mortality and morbidity rates. We suggest that the chronologic age of the patient should not deter aortic replacement.