Background: Over the past 10 years significant advances have been made in understanding the natural history and pathophysiology of aortic aneurysm disease. Despite a rapid improvement in alternative repair techniques, surgery for abdominal aortic aneurysm (AAA) remains the standard method of treatment. The aim of this study was to evaluate the efficacy of this treatment at a national level. Methods: Data for elective and emergency AAA procedures performed in England between 1989 and 1998 were obtained from the Department of Health Hospital Episode Statistics. Data for deaths secondary to ruptured and non-ruptured AAA in England for the same period were obtained from the Office of National Statistics. All figures represent age-adjusted incidence per 100 000 population. Results: The rise in elective and emergency AAA repair rates affected mainly men rather than women. The rise in death rates from ruptured AAA was 30·3 per cent in women and 2·0 per cent in men. Conclusion: Despite a considerable increase in elective AAA repair procedures in England, deaths from ruptured AAA continue to rise. These findings highlight the need for an efficient national strategy for improving the outcome of patients with AAA.