Endovascular repair (EVAR) for ruptured abdominal aortic aneurysm (AAA) has been held out as a safer, less invasive alternative to open surgery with the potential to significantly reduce in-hospital mortality. Despite the inherent biases that accompany comparison of the 2 treatment modalities, there appears to be a clear role for EVAR for select patients in select centers. To successfully treat patients with ruptured AAA both open and endovascular modalities should be available and clear protocols using a team approach must be developed.