Introduction - Abdominal compartment syndrome (ACS) may be a lethal complication after aortic surgery. Open abdomen (OA) therapy may be necessary using a temporary abdominal closure dressing. The aim of the study was to analyze the results of OA therapy with vacuum and mesh-mediated fascial traction (VACM) after aortic surgery. Methods - Patients were registered prospectively in clinical data-bases, case-records were reviewed retrospectively. Consecutive patients treated with OA and VACM after aortic surgery at six vascular centres 2006-2015 were included. Results - The study included 191 patients, 155 (81.2%) men. Median age was 71 years (IQR 66–76). The etiologies were; ruptured abdominal aortic aneurysm (RAAA) (69.1%), non-ruptured AAA (27.2%) and acute type B dissection (3.7%). Endovascular/hybrid and open repairs were performed in 49 and 142 patients, respectively. Among the 157 patients who were alive at termination of OA therapy, the duration of OA was 11 days (IQR 7–16). The primary delayed fascial closure rate was 91.8% (145/157), eleven patients underwent abdominal wall reconstruction, and one was left with a giant ventral hernia. Patients with OA initiated at secondary operation (N=88), compared to those left with OA at the primary operation(N=103) had; more severe OA status (p=0.006), more intestinal ischaemia (p=0.002), longer duration of OA (p=0.007), lower primary delayed fascial closure rate (p=0.003), more renal replacement therapy (RRT, p<0.001), longer intensive care unit stay (p=0.005) and higher in-hospital mortality (p=0.012). Nine patients developed entero-atmosperic fistulae, their mortality was 89%. Seven developed graft infections, all were diagnosed within 6 months, with a mortality of 28.6% at one year. In-hospital mortality was 39.3%. Intestinal ischaemia (OR 3.71, 95% CI 1.55–8.91]), RRT (OR 3.62 [95% CI 1.72–7.65]) and age (OR 1.12, [95% CI 1.06–1.12]), were independent factors associated with in-hospital mortality Conclusion - Vacuum and mesh-mediated fascial traction was associated with a high primary delayed fascial closure rate after often prolonged OA therapy following aortic surgery. Patient outcomes were better when OA was initiated at the primary operation, compared to at secondary operation.