OBJECTIVE Mortality of ruptured abdominal aortic aneurysm (RAAA) is still very high. Various factors contribute to the patients' mortality. Some of them could be affected. Therefore, we evaluate the main factors of mortality of patients with RAAA who were operated on at our University Vascular Center. METHODS Univariate and multivariate analysis of various factors associated with RAAA was performed in the group of 182 patients operated on for RAAA between 1 January 1992 and 1 September 2005. RESULTS The 30-day mortality rate was 33.5%. The main factors of mortality were: misdiagnosis, cardiopulmocerebral resuscitation (CPCR) on admission, configuration of RAAA (P<0.001), number of blood transfusions, hypotension on admission (P<0.0001) and duration of operation, type of reconstruction and hypertension in anamnesis (P<0.01). Important factors (P<0.05) of postoperative mortality were also low hemoglobin level on admission, abdominal aortic aneurysm (AAA) diameter and ischemic heart disease in anamnesis. The probability of patient's death is the highest (P<0.003), if factors like CPCR, number of blood transfusions and aneurysm diameter are combined (multivariate analysis, stepwise method). CONCLUSIONS The early detection and elective treatment of AAA, the regular dispensarization of patients with small AAA especially hypertonics, the correct diagnosis of RAAA without time delay are the best tools for patients' survival. The survival of patients with RAAA increases with a highly trained and experienced vascular team in a high volume vascular center.