Abdominal aortic aneurysm (AAA) repair is a complex surgical procedure and is commonly performed in a variety of practice settings across the United States. The quality of surgical care is neither ideal nor uniform across medical centers with documented variation in both utilization and outcomes. Recent data document that screening, though effective in reducing AAA-related deaths, may have only small contributions to population mortality. Large randomized trials have provided evidence regarding the timing of AAA repair and provide strong evidence for the development of appropriateness criteria. In general, lower mortality rates have been consistently associated with higher provider volume (surgeon and hospital) and specialization in vascular surgery. Current health policy initiatives suggest referral of several complex procedures to high volume centers based on minimum volume standards. Processes of care of high-volume providers and vascular surgeons should be studied and used to guide quality improvement efforts for lower volume providers and surgeons of other specialties performing AAA repair.