Background: The rupture of an abdominal aortic aneurysm is a highly lethal event, claiming approximately 15,000 lives each year. Traditionally, open surgical repair has been the mainstay for treatment. However, this surgery is associated with almost a 50% perioperative mortality rate. Minimally invasive endovascular stent grafts have been used with great success in the elective repair of aortic aneurysms. This technology has subsequently been applied to the repair of ruptured abdominal aortic aneurysms with a substantial reduction in the periprocedural death rate and associated complications.; Case Report: We report a case of a patient with a ruptured abdominal aortic aneurysm and an acute ST elevation myocardial infarction who was treated with an endovascular stent graft in a totally percutaneous fashion using only conscious sedation and local anesthesia.; Conclusion: Although the risk of mortality and complications remains high, endovascular repair of a ruptured abdominal aortic aneurysm offers the patient the best chance of survival.