After rapid palpation and visualization of the aorta and confirmation of the diagnosis of aneurysm, steps are taken to empty the abdominal cavity of small intestine. Unless the abdominal wall is quite thick, the greater portion of the small intestine can be retracted upward and to the right and inserted into a plastic bag, the mouth of which can be partly constricted by a tape (Figure 2). Saline is added to the plastic bag to keep the intestine moist. A sterile gauze pad is inserted into the neck of the plastic bag to avoid undue constriction and prevent the escape of the small intestine from the bag. It may be advisable (if the aneurysm is sizable and involves the right common iliac) to mobilize the appendix, terminal ileum, and cecum and to retract the right colon upward. The small and large bowels are retracted laterally and superiorly using multiple adjustable retractors. Additional exposure can be gained by dividing the peritoneum about the ligament of Treitz to permit further retraction of the small intestine upward and to the right (Figure 2). What at first may appear to be an inoperable aneurysm eventually may prove to be rather easily resectable, since the aneurysm tends to bulge anteriorly and seems to extend up so high as to suggest involvement of the renal vessels (Figure 3). The bulk of the aneurysm tends to come forward from under the left renal vein. The incised peritoneum over the anterior surface of the aneurysm is reflected by blunt and sharp dissection until the left renal vein is visualized. Blunt and sharp dissection frees the left renal vein from the underlying aorta (Figure 4). The left renal vein is retracted upward with a retractor (Figure 5) to gain additional space for the application of the occluding clamp to the aorta above the aneurysm. The left renal vein can be divided, if necessary, to gain the final exposure. It does not need to be reanastomosed if the adrenal and gonadal vessel veins are intact.