Anesthetic requirements for vascular surgery for aortic, carotid, brain aneurysm and peripheral vascular disease are reviewed. Peculiarities of the surgery which may impinge on anaesthetic management are discussed together with the pre-operative assessment issues of particular relevance to patients with generalized vascular disease.The detailed Recent advances in anaesthetic management for carotid and aortic endovascular repair is addressed. The lowered peri-operative stress and general morbidity levels which occur with endovascular surgery allow sicker patients with greater risk factors to present for this type of surgery, thus increasing the challenges facing anaesthetists.