Aortic aneurysms have been recognized since at least the 2nd century. However, little progress in their treatment was made until the early 1800s, when surgical ligation of these lesions sometimes proved successful. Until the mid 20th century, the most widespread approach was indirect treatment to provide palliation and prevent rupture. Such treatment involved introducing foreign materials into the aneurysm to promote blood coagulation or wrapping the aneurysm with plastic film to stimulate periarterial fibrosis. In 1888, Rudolph Matas introduced endoaneurysmorrhaphy, in which the diseased portion of the aorta was removed and a tunnel was constructed through the remaining healthy portion. This approach was widely used until the 1950s, when the advent of synthetic grafts allowed modern, direct repair. Emphasis began to be placed on excising aortic aneurysms and restoring pulsatile distal flow. In the 1980s, however, most surgeons reverted to the endoaneurysmorrhaphy technique—this time relining rather than removing the diseased portion of the aorta—thus bringing the history of aortic aneurysm surgery full circle. Today, an increasing number of aortic repairs are being achieved with endovascular methods, which offer new hope to patients at high risk for traditional aortic surgery.