A retrospective review of 80 ruptured infrarenal abdominal aortic aneurysms with classification of the patients into clinical groups based upon the findings at laparotomy was undertaken. Patients with small hematomas confined to the area of rupture were uniformly salvaged. Those with free intraperitoneal blood almost invariably died. Intermediate groups had mortalities of 37.5 and 62.5%. Operative mortality is related to the clinical group to which the patient belongs. Attention must be focused upon the potentially salvageable intermediate groups, with regard to early laparotomy and prompt, effective proximal and distal control of the aorta before entering the retroperitoneal hematoma. Major improvements in survival have occurred with smaller ruptures but little has been achieved with larger ruptures during the past 25 yr.