摘要The metamorphosis of abdominal aortic aneurysm (AAA) repair from open surgical to endovascular means has evolved substantially over the past 2 decades.Today,endovascular abdominal aneurysm repair (EVAR)is considered as the first choice of therapy for treatment of infrarenal AAA in patients with favorable morphology.Furthermore,in "real world" clinical scenarios,with increasing physician experience and ability,the indications of EVAR have expanded from treatment of elective to emergent aneurysms and from favorable morphology to sometimes complex and unfavorable anatomy,particularly in high-risk patients.1-4 When considering these endovascular techniques for treating ruptured AAA,one has to prepare for the challenges of streamlining patient care from the emergency room to the operating room and subsequent endovascular procedure that often requires a multidisciplinary approach and a change in paradigm and local cultures.This paper will focus on a comprehensive and standardized technical approach for treating patients presenting with ruptured AAA by endovascular means that can maximize our ability to offer this treatment of most patients and optimize outcomes.