Currently, two treatment options for ruptured abdominal aortic aneurysms (AAA) are available: conventional open surgical repair and endovascular minimally invasive repair. Open repair carries a significant morbidity and mortality rate, most probably due to the combined effects of general anaesthesia and surgical exposure. Based on anatomical characteristics as assessed by CT scan, approximately half of the patients with a ruptured AAA are eligible for endovascular minimally invasive repair. The majority of comparative studies show a clear trend towards a lower perioperative mortality rate for endovascular repair compared to open surgery (18-24% and 34-38%, respectively) and more rapid recovery. However, these mainly observational studies show considerable heterogeneity. Furthermore, potential selection bias, where patients with a more favourable anatomic and haemodynamic profile are more likely to be selected for endovascular repair, makes a proper comparison barely possible.The potential benefits of endovascular repair over open surgery are currently being evaluated in a large randomised study.