Abdominal aortic aneurysms are one of the more common problems faced by the vascular surgeon. A review of 898 aneurysms resected at the University of Rochester from 1955 to 1982 revealed a sequential decrease in mortality for elective surgery from 13% in 1955 to 1965, to 8.4% from 1966 to 1973, and 5.6% in the last 8 years. Mortality for resection of ruptured aneurysms remained high (70%). The incidence of ruptured aneurysms has not changed significantly in the last 16 years. For 1980 and 1981 we calculated the hospital costs of surgical treatment of abdominal aortic aneurysms. The mean total cost after elective resection was +10,114 compared with +18,223 after rupture. Increased costs after rupture reflected both a longer stay and more intensive and expensive medical care. Using discharge data from U.S. hospitals in 1979, we extrapolated our cost and mortality data to a national level. Assuming a mortality rate for elective resection of 5% and a mortality rate for resection after rupture of 50%, we estimated that in 1979 +50 million and over 2000 lives could have been saved if patients with abdominal aortic aneurysms had been identified and subjected to elective resection. The incidence of ruptured abdominal aortic aneurysms remains unacceptably high. Mortality from this disease can best be reduced by increased physician awareness and prompt surgical referral.(ABSTRACT TRUNCATED AT 250 WORDS)