Background: The literature reporting the long-term survival following surgery for abdominal aortic aneurysm (AAA) tends to be confusing, As a result, many clinicians looking after patients with AAA may be uncertain about the five-year survival of a given patient. This is in marked contrast to the situation for patients with malignant disease, With the current interest in population screening and endoluminal stenting for AAA, an understanding of long-term survival is increasingly important,Methods: Thirty two publications in the English language over the last 20 years, containing data pertaining to five-year survival following routine elective surgery for AAA in unselected patients, were identified using Medline searches.Results and conclusions: A range of important methodological differences were noted. The mean five-year crude survival was about 70% while the expected survival of a matched population was close to 80%. Survival was further reduced by about 10% in cases with significant coronary heart disease. Age alone is not a predictor of long-term relative survival with octogenarians who survive beyond 30 days surviving longer than an age-matched population. (C) 2001 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.