Abdominal compartment syndrome is a lethal yet under appreciated complication of vascular surgery. The World Society of Abdominal Compartment Syndrome conference in 2004 culminated recent research to formulate the internationally accepted definitions and promote education, in an attempt to reduce a quoted 82% mortality. The syndrome has a broad aetiology, many of which are pertinent to vascular surgery and particularly to ruptured aortic aneurysms. It is defined as an intra-abdominal pressure greater than 12 mm Hg or an abdominal perfusion pressure less than 60mm Hg, in the presence of end organ dysfunction and ultimately leads to multi-organ failure. The physiological derangements which occur in all major organ systems are generally well documented and an understanding of them paramount to early recognition. Numerous methods have been devised to measure intra-abdominal pressure and ideally, measurements utilising a catheter and pressure transducer should be taken in high risk patients yet very few clinicians have measured it. This is essential for diagnosis and also allows grading of the hypertension as clinical and radiological examination does not provide any conclusive information. Appropriate post operative wound closure has an important role in prevention of the syndrome, which would otherwise be treated by surgical decompression. Negative pressure dressings appear to be most beneficial but further prospective trials are required to clarify this.