The hospital records of 59 patients treated for ruptured abdominal aortic aneurysms during the past eleven years were reviewed. The patients were classified into two groups: an elderly group aged 80 years old or wore (18 cases) and a control group aged under 80 years old (41 cases). Previous diagnoses of abdominal aortic aneurysm had been made more frequently in the aged group (44.4%) than in the control group (22%). Of the patients who fell into shock preoperatively, only 6 patients (60%) received graft replacements in the aged group, but all patients received graft replacements in the control group. Graft replacements were performed as safely in non-shock patients in the elderly group as in cases of non-ruptured abdominal aortic aneurysm. The overall survival rate including non-operative cases in the elderly group (38.9%) was lower than that in the control group (61%). The survival rates in patients receiving graft replacemes showed no significant difference between the elderly group (63.3%) and the control group (67.6%). Many of the aged patients who fell into shock due to aortic rupture died without receiving surgery. Hypovolemic shock which results in ischemia in vital organs is the most likely major cause of death in patients of advanced age. In conclusion, graft replacements should be performed electively and safely before aneurysmal rupture, particularly in elderly patients.