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Ruptured abdominal aortic aneurysm remains one of the most common vascular emergencies, even though mortality from ruptured aneurysm has been declining at the population level. Without repair, ruptured aneurysm is nearly always fatal. The 30 day mortality from emergency open repair has remained at nearly 50% for many years, but findings from national datasets suggest that emergency endovascular aneurysm repair (EVAR) may be associated with a lower 30 day mortality rate of about 30%. Such data may be subject to major confounding bias. Many patients with ruptured aneurysm have aortic morphology that is unsuitable for conventional EVAR. Observational studies do not consider centres' expertise, which potentially influences selection of patients and diagnostic criteria.

The authors of this study set out to assess whether a strategy of endovascular repair (if aortic morphology is suitable, open repair if not) versus open repair reduces early mortality for patients with suspected ruptured abdominal aortic aneurysm.

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