OBJECTIVE To report our early experience with endovascular treatment of patients with ruptured abdominal aortic aneurysms (RAAAs). METHODS Between March 1998 and October 2004, 40 consecutive patients with an RAAA presented to our unit; 38 underwent assessment by computed tomography, whereas 2 died on arrival before any assessment and treatment was possible. Twenty-three patients (61%) were suitable for stent grafting, and all proceeded to endovascular repair. Of these, 17 underwent operation with local anesthesia, 1 did so under general anesthesia, and a further 5 procedures were commenced under local anesthesia and converted to general anesthesia. A total of 14 bifurcated and 10 aortouni-iliac stent grafts were implanted; in 1 patient, the bifurcated graft was converted to an aortouni-iliac repair during surgery because of technical difficulties. RESULTS Stent-graft deployment in the intended location without a type I or III endoleak was technically successful in 22 of the 23 patients. There were no conversions to open surgery. The 30-day mortality was 39%. Six patients died immediately or soon after the procedure because of severe hypovolemic shock, and three died within 30 days from cardiac causes. After surgery, 13 complications were encountered in 10 patients (3 cardiac, 4 respiratory, 5 renal, and 1 implant related). Two patients required reintervention--one for a type I endoleak and one for limb occlusion. There were 14 survivors. During a median follow-up of 410 days (range, 90-1650 days), 2 more patients died from myocardial infarction, and 9 remain well; 3 patients were lost to follow-up. There were three secondary interventions (two for type I endoleak and one for stent-graft thrombosis). CONCLUSIONS Endovascular treatment of RAAAs is feasible, and the early experience is promising. More experience and evidence from randomized trials are needed to determine whether such an approach is superior to open surgery.