Flow mediated dilatation (FMD) deteriorates during abdominal aortic aneurysm (AAA) progression, and is improved by AAA surgery. FMD reduced significantly between assessments during AAA surveillance (from a median of 2.0% at baseline to 1.2% at follow-up, Wilcoxon matched pairs signed rank test [WMPST] p = .004). FMD was measured in 50 patients prior to AAA surgery, and repeated 8–12 weeks afterwards. FMD improved significantly after surgical repair (from 1.1% pre-operatively to 3.8% post-operatively, WMPST p < .001), irrespective of the type of surgery performed (endovascular repair [EVAR] n = 28; open surgical repair [OSR] n = 22).