Background and Aims Ruptured abdominal aortic aneurysm (rAAA) is the most severe complication of abdominal aortic aneurysms, characterized by rapid progression and high mortality. Timely diagnosis and treatment are critical, with endovascular aneurysm repair (EVAR) currently serving as the first-line treatment. This study was conducted to evaluate the safety, efficacy, and short- to mid-term outcomes of EVAR for rAAA under standardized emergency protocols.Methods The clinical data of 22 patients with rAAA who underwent EVAR at Yunnan Fuwai Cardiovascular Hospital from January 2018 to October 2024 were retrospectively analyzed. The cohort included 16 males and 6 females, with a mean age of (67.2±10) years. The mean maximum aneurysm diameter was (70.6±9.2) mm, and all cases were infrarenal rAAA with a mean aneurysm neck angle of (107.9±54.3)°. All patients were diagnosed preoperatively via total aortic and coronary computed tomography angiography (CTA) and treated with EVAR under standardized emergency protocols. Perioperative clinical data, along with follow-up CTA findings at 1 week, 1 month, 6 months, 12 months, and annually thereafter, were collected. Outcome measures included aneurysm sac thrombosis rate, stent morphology, type and incidence of endoleaks, and iliac branch patency rate.Results The procedural success rate was 100%. Intraoperative angiography revealed type I endoleak in 6 cases, which were successfully managed using balloon dilation, short stent implantation, or a combination of coil embolization and biologic glue to seal the aneurysm sac. Post-treatment angiography showed resolution or significant reduction of the endoleak. The mean operative time was (162.1±63.6) min, with an average transfusion of (736.4±532.3) mL of packed red blood cells. After operation, the average stay in the SICU was (8.76±1.0) h, and the mean hospital stay was (8.1±4.5) d. There were 6 deaths within 30 d after operation. Two patients had minor type Ⅱ endoleak detected on CTA at 1 week, which required no special intervention; these endoleaks reduced by 1 month and resolved by 3-6 months. One patient developed a type Ib endoleak at 2 years after operation, which was successfully managed with reintervention. The remaining patients had no endoleaks, no iliac branch occlusions, and satisfactory aneurysm sac thrombosis.Conclusion EVAR under standardized emergency protocols is safe and effective for treating rAAA, with satisfactory short- and mid-term outcomes. Type Ⅰ endoleak can be reliably managed using techniques such as balloon dilation, short stent implantation, and coil embolization with biologic glue, demonstrating a safe and effective treatment approach.