Experience with retroperitoneal approach to the abdominal aorta for aortic reconstruction in 30 cases is reported. The authors' interest in this exposure stemmed from observations made at the time of scoliosis surgery. The technique was modified and used in poor risk patients and resulted in a significant decrease in operative morbidity and hospitalization. A literature review revealed that several modifications have been described dating back as far as 1836. The authors emphasize technical features and advantages and disadvantages of this approach.