The advent of endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms. EVAR has evolved into the preferred treatment for abdominal aortic aneurysms with suitable anatomy. Several randomized clinical trials have confirmed that EVAR reduces short-term morbidity and mortality. Despite vast improvements in diagnostic imaging, open surgical repair techniques and the care of critically ill patients over the past two decades rupture of abdominal aortic aneurysms still carries an extremely high morbidity and mortality. To improve outcomes in treatment of rAAA a movement has occurred away from open repair and toward EVAR as a paradigm shift that may help to improve otherwise dismal results. In the past 10 years, numerous studies including meta-analyses, administrative databases and randomized control trials have investigated the presumed advantages of EVAR over open repair. This review summarizes the world wide experience for ruptured AAA repair and addresses the role for standardization of care with the use of aortic aneurysm protocols.