It was built under the reign of Emperor Alexander Severus to supply his enlargement of the Baths of Nero, which were renamed Thermae Alexandrinae.

The Aqua Alexandrina received its water from the Pantano Borghese swamp near the city of Gabii, now a part of Monte Compatri.

The longest continuous above-ground stretch of the aqueduct runs through the district of Centocelle along Via dei Pioppi and Via degli Olmi.

It is possible to follow the aqueduct from Centocelle towards Pantano Borghese through open fields and scattered farmsteads until the Grande Raccordo Anulare, the great ring road of Rome.

There are significantly lower arched stretches at the crossing points of ditches and hollows for example behind the Tor Tre Teste housing estate where a public park was established around the ruins.