Aim: Repair of the abdominal aorta is a major procedure that has a considerable morbidity and mortality. Efforts are exerted to reduce this operative risk, one of which is the surgical approach of the Aorta. This study was carried out to evaluate the retroperitoneal approach regarding morbidity and mortality during the operation and for 30 days afterward and to evaluate the accessibility of this approach while the patient in supine. 
Methods: Nineteen patients with a mean age of 65.5 years were admitted for the repair of Abdominal Aorta between March 2004 and March 2006. To repair the Aorta of these patients it was approached retroperitonealy, using the standard technique with modification of the patient's position. Operative and post-operative data were measured and compared to the literature. 
Results: Mean operative time, intra-operative fluid replacement and ICU stays were less compared to the transperitoneal 
approach. Normal intestinal sounds were regained after 2 days in most of the patients. Mean hospital stay was 6.7 days with no mortality. 
Conclusion: This study supports that retroperitoneal approach has early morbidity and mortality that is comparable to the accepted rate of complications in literatures. This approach provides a convenient exposure to treat different anatomical 
lesion of the distal Aorta and iliac arteries, when we operate with the patient in the neutrally supine position.