CTA of a 65-year-old gentleman who presented to the emergency department with hypotension and abdominal and back pain. (A) Axial image demonstrating peri-aortic stranding and hematoma at the level of the renal arteries (white arrow); (B) more distal axial image of the same patient in (A) with peri-aortic hematoma extending into the retroperitoneal space (white solid arrow), consistent with a ruptured AAA. The aneurysm sac measures 6.5 cm (white dashed arrow). CTA, computed tomography angiography; AAA, abdominal aortic aneurysms.The aortic diameter can be overestimated with CTA if oblique cuts of the aorta are obtained secondary to vessel tortuosity. For this reason, CTA is often combined with three-dimensional (3D) reconstruction. Post-processing programs are able to use data obtained from CTA to reconstruct a 3D model so that centerline measurements via orthogonal planes are possible (). This enables more accurate aortic diameter measurements and helps in preoperative planning, particularly for endovascular stent graft repairs (). For infrarenal AAAs, curved planar reformats are helpful in determining the axial length of the aneurysm neck (distance from the lowermost renal artery to the beginning of the aneurysm) as well as neck angulation and condition (). Noting the length, tortuosity, and condition of the iliac arteries is important; in 5–46% of cases, aneurysmal disease extends into the iliac system (). When reviewing a CTA of the aorta for preoperative planning, one should take note of the number and location of the renal arteries as well as the presence of a retroaortic left renal vein (). The mesenteric vessels should also be reviewed, ensuring a communication between the middle colic and superior left colic arteries, as the inferior mesenteric artery is usually sacrificed or occluded with infrarenal AAA repair. Knowing the location of the renal and mesenteric vessels as well as the character of the suprarenal aorta is useful in determining either a clamp location or landing zones for open and endovascular repair, respectively., This article will explore what’s unique about an infrarenal abdominal aortic aneurysm, why they develop, and what symptoms you might experience if you have one., Currently, EVAR is the primary treatment method for the repair of infrarenal aortic aneurysms due to improved short-term morbidity and mortality outcomes. This article is intended to review the current status of the management of infrarenal abdominal aortic aneurysms (AAA)..