The records of 206 aneurysmectomy patients over the age of 70 years were reviewed. Increased three- and five-year mortality was seen with a variety of risk factors—cerebral vascular disease, cardiac disease, diastolic hypertension, renal disease, and cigarette smoking—but 30-day mortality was not affected. Age was not a significant risk factor. It is recommended that patients with aneurysms less than 7.5 cm be observed if multiple risk factors are present. Almost all patients with aneurysms greater than 7.5 cm should have resection to prevent death from rupture, although this will be short-term palliation in patients with multiple risk factors.