Management of an aneurysm depends on the size of the aneurysm, its rate of expansion, the presence of other forms of heart disease, and the gender and age of the patient. In general, physicians will not recommend surgery for smaller aneurysms that have little risk of rupturing. Instead, antihypertensives to treat high blood pressure might be prescribed, especially beta blockers because they also decrease the force on the arterial wall. As a result, these medications may be able to slow the rate at which the aortic aneurysm expands. Other medications that may be prescribed include cholesterol-reducing drugs to lower cholesterol levels. Quitting smoking is also an important part of therapy.

If, however, the aneurysm is larger, has symptoms, or there are other factors that might increase the risk of rupture, surgery may be recommended. In 2005, the American College of Cardiology and American Heart Association (ACC/AHA) issued guidelines to help physicians decide when to perform surgery. The ACC/AHA recommended that aneurysms between 4 and 5.4 centimeters be monitored yearly by ultrasound or CT scanning, while aneurysms between 3 and 4 centimeters should be monitored by ultrasound every two to three years.

Traditional surgery requires the abdomen (or chest if the aneurysm is thoracic) to be opened surgically. The bulging section of the aorta is excised (surgically removed) and the remaining blood vessel reconnected using a synthetic graft. In recent years, this surgery has become quite safe, with a success rate of about 90 percent. Risks of surgery include kidney failure, infection, bleeding and formation of a false aneurysm.

Alternatively, a physician may use special stents called stent-grafts to repair abdominal aortic aneurysms. According to the American Heart Association, this option is generally recommended for patients who at high risk of surgical complications. Stent-grafts are not currently recommended for treatment of thoracic aortic aneurysms. During the stent-graft procedure (also known as endoluminal aortic stent-grafting or endovascular repair), the physician prevents blood from flowing through the aneurysm by placing one stent just above the aneurysm and a second stent just below the aneurysm. The two stents are connected by a tube of synthetic material (a graft), which provides a channel for blood to flow without entering the aneurysm. Because the grafts are delivered via a catheter, the use of grafts is less invasive than traditional surgery. And the grafts allow the aneurysm to be bypassed rather than removed, the procedure results in less trauma to the blood vessels.

The success rate of using stent-grafts to treat abdominal aortic aneurysms has risen to 90 percent, although the long–term safety of these devices is still unknown, and in recent years, several abdominal aortic aneurysm stent grafts were removed from the market. Complications with this procedure include the risk of blood leaking from the graft, known as endoleak. There are several types of endoleaks, the most serious being if the blood leaks into the aneurysm. This will increase the risk of rupture.