Ruptured abdominal aortic aneurysm (rAAA) is characterized by a rapid onset, severe progression and high mortality and so far, open repair is still the predominant procedure for rAAA. In this paper, the author discusses the prevention and management of perioperative complications in open repair for rAAA, from three aspects: diagnosis, intraoperative considerations and postoperative management. It is pointed out that equal attention must be paid to both prevention and treatment of the complications of rAAA. The emphasis of prevention is placed on improving diagnosis, reducing blood loss, decreasing the time to aortic occlusion and maintaining hemodynamic stability; the essential strategy for treatment is based on early detection, ascertaining the causes and eliminating predisposing factors, and relieving symptoms.