During a 12 year period ending in 1977, 65 patients had surgical treatment of ruptured abdominal aortic aneurysms. Hospital mortality was 48 per cent (31/65 patients). Preoperative shock (P = 0.05), intraoperative blood loss (P less than 0.01), postoperative respiratory complications (P less than 0.05) and renal failure (P less than 0.05) all significantly influenced early mortality as did multiple subsystem complications (P less than 0.01). Late mortality was 26 per cent, comparable to series of unruptured aortic aneurysm resection survivors. Increased awareness of the problem by physicians, and hence, more aggressive elective treatment of abdominal aortic aneurysms should lower the frequency of this problem, and improved intraoperative and postoperative care should improve survival of those patients whose aneurysms rupture.