Leaking abdominal aortic aneurysms must be considered as acute symptomatic aneurysms. Mainly in the very old patient the natural course of the disease is very doubtful. Therefore surgical repair seems to be necessary in nearly all cases. Special operative techniques such as tube resection as well as inlay technique are able to reduce the operative risk. Pharmacological control of blood pressure during surgery is as necessary as postoperative intensive care treatment.