Background: Endovascular aneurysm repair (EVAR) has become a common approach to the management of ruptured abdominal aortic aneurysms (rAAA). The use of iodinated contrast during EVAR for rAAA has several disadvantages, including contrast nephropathy, potential allergic response, and the need for high-pressure injection. We evaluated the use of carbon dioxide (CO2) as the primary contrast agent for endovascular repair of ruptured aortic aneurysms. Methods: Between December 2007 and July 2009, we retrospectively reviewed our experience with patients undergoing endovascular repair of rAAA, with CO2as the principal contrast agent, and compared them with patients who underwent EVAR using iodinated contrast. Results: Four patients underwent endovascular repair of rAAA with CO2 angiography (group 1) and seven with iodinated contrast (group 2). The mean age of the patients was not different between groups (p = 0.353). Patients in group 1 received a mean of 443 ± 99 mL of CO2 and 4.3 ± 8.5 mL of iodinated contrast. Patients in group 2 received 110.2 ± 37.6 mL of iodinated contrast (p < 0.001). Overall mortality was not different between group 1 (0.0%) and group 2 (28.6%, p = 0.491). In patients who survived to discharge, the change in creatinine between admission and discharge was greater in group 2 although not statistically significant (0.25 ± 0.19 mg/dL for group 1 vs. 0.58 ± 0.25 mg/dL for group 2, p = 0.066). There was no significant difference in length of stay between group 1 (intensive care unit, 1.00 ± 0.82 days; hospital, 4.25 ± 0.96 days) and group 2 (intensive care unit, 3.60 ± 3.44 days; hospital, 9.00 ± 6.60 days). Conclusions: Endovascular repair of rAAA using CO2 as a contrast agent is technically feasible and safe. The potential benefits of CO2 angiography support the continued use of CO2 in cases of ruptured aneurysms. Further studies are necessary to determine whether CO2 improves survival and limits the progression of renal dysfunction after endovascular repair of rAAA.