Endovascular treatment of ruptured abdominal aortic aneurysms (REVAR) is increasingly used. Retrospective pooled data indicate that REVAR is associated with decreased morbidity and mortality, but in two small randomized clinical trials this has not been evidenced. However, REVAR seems associated with lower total costs and better long-term survival rates than open surgical repair. Consequently, REVAR could be at least as good a treatment as open surgery in suitable patients, when local facilities and expertise exist.