Background and Aims Rupture is the most serious complication of abdominal aortic aneurysm, requiring rapid diagnosis, emergency surgery, and posing significant surgical challenges, with high mortality rates. Currently, there is very limited reporting on ruptured abdominal aortic aneurysm (rAAA) in our country, which presents numerous difficulties for the prevention and treatment of rAAA. This study collected the data of epidemiological characteristics, treatment outcomes, and prognosis of rAAA patients from multiple centers with a large sample size, analyzing the current status and trends of rAAA surgery in China over the past decade, aiming to provide reference for clinical practice.Methods The clinical and follow-up data of 161 rAAA patients treated at five major vascular surgery centers (50 from Drum Tower Hospital Affiliated to the Medical School, Nanjing University; 19 from the First Affiliated Hospital of Anhui Medical University; 33 from the Second Affiliated Hospital of Nanchang University; 31 from Qilu Hospital, Shandong University; and 28 from the First Affiliated Hospital of the University of Science and Technology of China) were retrospectively analyzed.Results Among the 161 patients, 124 (77.02%) were male and 37 (22.98%) were female, with an average age of 68.27 years. The median age at diagnosis was 70 years for males and 71 years for females. The overall mean aneurysm diameter was 7.11 cm, with males at 7.72 cm and females at 6.82 cm, showing a statistically significant difference (P<0.05). The main comorbidities were hypertension and coronary artery disease. Over 80% of patients presented with abdominal pain as the initial symptom, while 15% presented with low back pain, and 8 patients sought medical attention for dizziness or visual disturbances. Among the 161 patients, 86 underwent open surgical repair (OSR), and 75 received endovascular aneurysm repair (EVAR). The proportion of EVAR has increased annually, reaching nearly 70% in the past five years, and up to 90% in patients aged over 70 years. All OSR procedures were performed under general anesthesia, while 20 EVAR cases used local anesthesia and 55 used general anesthesia. Compared to the OSR group, the EVAR group showed significant differences in operative time (231.77 min vs. 162.49 min), intraoperative blood transfusion volume (1 578.56 mL vs. 843.87 mL), length of hospital stay (21.21 d vs. 15.34 d), ICU stay duration (8.28 d vs. 5.49 d), and hospitalization costs (108 500 CNY vs. 132 800 CNY) (all P<0.05). No significant differences were found between the EVAR and OSR groups in total complications or perioperative mortality rates (both P>0.05). The main causes of perioperative death included respiratory and circulatory failure, acute myocardial infarction, and severe infections. Postoperative follow-up was effectively conducted for 92 patients, with follow-up durations ranging from 10 to 142 months. Survival analysis revealed no significant difference in survival rate between the OSR and EVAR groups (P=0.318 2).Conclusion rAAA is a rare and high-risk disease, with certain clinical differences between male and female patients. The number of EVAR procedures has increased rapidly; however, EVAR has not shown a significant advantage over OSR in improving long-term survival rates.