The successful surgical treatment of three patients with primary aortoduodenal fistulae was achieved in a retrospective analysis. The treatment of this rare disorder included primary duodenal closure, resection of the atherosclerotic aneurysm, and placement of a Dacron graft. A review of the literature demonstrated only 18 survivors with this surgical problem. These three additional cases emphasize that primary duodenal repair and Dacron graft replacement of the aneurysm may be performed instead of an extra-anatomic bypass.