Purpose: To assess the effectiveness of routine MSCT in the planning of endovascular and open surgery of AAA. Patients and Methods: A series of 42 consecutive patients was prospectively examined by MSCT (Siemens Sensation 16®, arterial phase, bolus tracking threshold=200HU, 75mm collimation) for AAA surgery planning. MPR, MIP and VRT reconstructions were routinely obtained. In four cases previous DSA was available for comparison. Results: AAA was classified infrarenal (28/42), iuxtarenal (10/42), pararenal (2/42) and thoraco-abdominal (Crawford type IV) (2/42). In 27/42 AAA maximum diameter was greater than 45mm; involvement of a single iliac artery (6/42) or both (7/42) was also observed. Vascular anomalies were detected in 54.8% of patients. Overall, 22 accessory renal arteries, 4 visceral aneurysms (2 renal arteries, 1 celiac trunk, 1 SMA) and 1 retroaortic renal vein were detected. Patency of IMA was demonstrated in 25/42 AAA. Based on MSCT data 11 patients were treated (7 by open surgery, 4 by endovascular approach). No discrepancy was observed concerning the planned infrarenal clamping, all accessory renal arteries were identified at surgery. In all AAA, endovascular treatment planning matched the actual geometry of vessels. Conclusions: Although this series is limited, information provided by axial images, MPR, MIP and VRT reconstructions fulfilled all requirements for routine planning of both open and endovascular treatment of AAA. Moreover, VRT reconstructions enable a more precise assessment of accessory renal arteries origin and course and spatial orientation of AAA neck.