Technical refinements in the strict sense (improvements of endovascular techniques) may help to further improve the results of emergency endovascular aneurysm repair. However, major improvements in clinical results of emergency EVAR concern the overall management of patients with ruptured abdominal aortic aneluysms. Standard operating procedures in the management of acute aortic lesions, emergency EVAR protocols, preoperative diagnostic imaging, the concept of hypotensive hemostasis, the use of transfemoral supraceliac aortic balloon occlusion, the use of local anesthesia, timely diagnosis and treatment of abdominal compartment syndrome and logistic issues may therefore be seen as technical refinements in the wider sense. This chapter highlights each of these technical issues and the authors expose how they are handled in their institution. Additionally, the concept of damage control endovascular aneurysm repair (dEVAR) is discussed.