Purpose: The mortality rate for elective repair of abdominal aortic aneurysm (AAA) has gradually decreased to approximately 5%. However the mortality rate for ruptured AAA (RAAA) has not changed significantly and continues to be 45% to 50%, and the mortality rate exceeds 90% if deaths occurring before patients reach the hospital are included in the statistics. The aim of this study was to determine what factors are associated with operative death in patients with RAAA. Method: For January 1997 and December 2003, 35 patients underwent surgery for RAAA. The factors of the preoperative status included age, gender, history of loss of consciousness, mental change, hemodynamics, the serum creatinine level and the patients' comorbidities were analyzed. As for the aneurysmal factors, the site, etiology, maximal diameter and rupture status of the aneurysms were evaluated. Finally operative factors including the operation time and status, surgeon, type of grafting, renal dysfunction during operation and the amount of blood transfusion were also analyzed. As the statistical method, Fischer's exact test and multi-step logistic regression method were used. Result: The 30-day mortality rate was 17.1% (6/35). By univariate analysis, mental change, increased preoperative serum creatinine level (＞2 mg/dl), intraoperative renal dysfunction, prolonged intraoperative hypotension over 30 minutes, the amount of transfusion, diameter of aneurysms and surgeon's experience were statistically significant. On multivariate analysis, the amount of transfusion and intraoperative renal dysfunction were defined as the significant risk factors. Conclusion: To reduce the operative mortality of RAAA, preventing massive bleeding and the subsequent acute renal failure by early operative control of bleeding, fluid resuscitation and maintenance of blood pressure are important.