The aim of this study was to compare the perioperative outcomes and cost effectiveness between open surgical repair (OSR) and endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs). A retrospective review was performed of the demographic characteristics and perioperative outcomes from 59 RAAA patients undergoing OSR or EVAR at our center between January 2003 and November 2014. The clinical efficacy was evaluated and compared between the OSR group and the EVAR group. The cost-effectiveness of the two groups was compared in terms of length of stay and cost of hospitalization. Data were obtained from Department of vascular surgery, Zhongshan Hospital, Fudan University. 23 patients underwent OSR, and 36 patients underwent EVAR. The overall 30-day mortality was 36.5% and was not statistically different between the 2 groups (47.8% OSR vs. 27.8% EVAR, P =0.14), but it tended to a lower mortality in the EVAR group. A KaplaneMeier survival curve analysis showed no significant difference between the 2 groups (P =0.079). The mean length of stay was prone to be longer in the OSR group (27.9 ± 21.9 days) than that in the EVAR group (17.9 ± 14.2 days, P= 0.062). In terms of the cost of implants, direct costs and medical consumables, EVAR group was significantly higher than OSR group.In summary, EVAR had superior perioperative advantages, but the direct cost of EVAR group was higher than that of OSR group, and the indirect cost was lower than that of OSR group. To determine the cost of two treatment methods, a larger sample size is needed for analysis, so that ICER value can be determined. In an experienced vascular center in China, EVAR has superior perioperative advantages. Therefore, the large-scale, multi-center, randomized controlled studies are deserved to be carried out actively on the focus of the cost of treatment.