The typical clinical manifestations are: sudden mid-abdominal or low back pain, shock and abdominal pulsating mass, however, only 1/3 of patients have the above triad. The pressure of the ruptured AAA tumor increases, which causes the pulling and squeezing of nerve fibers and results in continuous pain in the abdomen or low back, mostly on the left side, and it is a sharp, knife-like pain that may radiate to the groin and thighs. After rupture, abdominal pain can be relieved to some extent due to sudden pressure reduction. 80% of AAA rupture bleeding is first confined to the retroperitoneum, so only back pain and abdominal pain can be manifested at the earliest, and as bleeding increases and then breaks into the abdominal cavity, hypovolemic shock can appear. Some patients with AAA rupture into the retroperitoneal space for several hours, days or even weeks without rupture into the abdominal cavity, called “wrapped” rupture. In 20% of cases, the AAA ruptures into the abdominal cavity, which manifests as sudden shock, and some patients die of hypovolemic shock before they can reach the medical institution. If the AAA ruptures into the inferior vena cava, the patient may develop lower extremity edema, congestive heart failure, and persistent abdominal tremors, as well as systemic arterial insufficiency including angina pectoris, oliguria, lower extremity and intestinal ischemia. In 10% to 17% of patients with ruptured AAA, the hematoma stimulates the nociceptive fibers of the ureter in the retroperitoneal sympathetic plexus, resulting in ureteral colic-like manifestations, and the large hematoma may occasionally compress the ureter and cause obstruction, or it may compress the bile duct and present obstructive jaundice. It may also compress the bile duct and present with obstructive jaundice. Diagnosis In middle-aged and elderly people with unexplained distension, low back pain, deficiency and shock, especially those with a previous history of AAA and the presence of triadic manifestations, the possibility of the disease should be considered, and the diagnosis is not difficult to establish when combined with the necessary tests. It is important to emphasize that the diagnosis and treatment of ruptured AAA should be carried out at the same time, and a lot of time should never be wasted in saving the patient’s life by performing various tests to clarify the diagnosis, and all necessary ancillary tests should be performed under the condition that the patient’s vital signs are relatively stable and closely monitored. Meanwhile, ruptured abdominal main vein aneurysm should usually be differentiated from the following diseases: ureteral colic, lumbar disc herniation, acute pancreatitis, peptic ulcer perforation, acute cholecystitis, hemorrhagic intestinal obstruction, etc. 1, laboratory tests: check blood, urine routine, coagulation function, blood group identification, electrolytes, renal function, blood glucose examination, blood cross preparation. 2, abdominal ultrasound: can be performed at the bedside, good repeatability, does not affect resuscitation and resuscitation, and can also be used to identify other diseases in the abdomen. 3.CT examination: it is extremely helpful to perform CT examination for those who are hemodynamically stable, such as those who are not obvious or have atypical symptoms and have difficulty in confirming the diagnosis. It can determine the location, size, scope of AAA and the degree of intra-abdominal and retroperitoneal bleeding, and can also be used for differential diagnosis, and has important reference value for the development of the correct treatment plan. 4.Electrocardiogram: It can exclude myocardial infarction, pulmonary artery embolism and other disorders and can understand the status of cardiac function to guide perioperative treatment. 5.Other：Platinum of chest and abdomen can be used to understand whether there is thoracoabdominal aortic aneurysm or aortic coarctation aneurysm. The correct and rapid diagnosis of ruptured AAA is one of the keys to successful treatment, and diagnosis and treatment are often carried out simultaneously. Even if surgery is successful, the incidence of postoperative organ complications such as cardiac, renal, pulmonary and cerebral complications is much higher than in patients undergoing elective surgery. Age and other comorbidities are not absolute contraindications to emergency surgery for ruptured aneurysms. The key to treatment lies in active and effective resuscitation, rapid control of bleeding, rational choice of surgical procedure and careful perioperative monitoring. 1. Resuscitation and monitoring Establish two or more open venous accesses, preferably a central venous line to monitor central venous pressure and a Swan-Ganz catheter to monitor circulatory dynamics. Place a catheter to monitor urine output, and lap band the abdomen to prevent increased abdominal pressure from aggravating bleeding. Actively treat hypovolemic shock, replenish crystalloids and colloids, and fill with vasoactive drugs to maintain systolic blood pressure at 80-100 mmHg to prevent bleeding from being aggravated by high blood pressure. The patient’s hypothermia can be corrected by air conditioning, electric blanket, etc. The fluid input should also be preheated to prevent hypothermia from causing cardiac dysfunction, abnormal coagulation mechanism or even DIC. 2. Preparation of the operating room (1) Prepare autologous blood recovery equipment. (2) Radial artery cannulation and monitoring of arterial blood pressure. (3) Place a central venous line for pressure measurement, preferably with a Swan-Ganz catheter in the right atrium. (4) Electrocardiographic monitoring (5) Computerized brain tracing is applied to monitor the functional status of the brain, which can be adversely affected by conditions such as blockage of cerebral blood supply or the occurrence of any hypoperfusion pressure, hypoxia, and high or low partial pressure of carbon dioxide, first manifesting changes in brain waves. (6) Nasopharyngeal temperature can reflect intracranial temperature and rectal temperature can represent body-brain temperature. It is important to control the body temperature at the expected level to minimize the effects on the functions of the heart, brain, kidneys, lungs and spinal cord during ischemia. (7) Vascular surgical instruments, artificial blood vessels (Y and straight), vascular sutures, etc. 3.Control of bleeding The key to surgical treatment is to quickly and effectively block the proximal end of the ruptured aorta to control bleeding and improve the circulatory status. (1) Transthoracic block method: The left anterolateral 6th or 7th intercostal opening is used, and the descending aorta is blocked diaphragmically to control abdominal bleeding. Although this method increases the surgical trauma, it can complete the block in a short time to avoid blind clamping and blocking in a large amount of accumulated blood, and it can observe the heart pulsation under direct vision, but the disadvantage is that the ischemia time of the abdominal organs is prolonged. It is better for another group of surgeons to open the abdomen rapidly at the same time and strive to block the abdominal aorta at the subrenal level to minimize the ischemic time of the spinal cord and viscera. (2) Block above the level of the renal artery under the diaphragm: After entering the abdomen, when cutting the small mesh, the left finger purely separates the foot of the diaphragm to reveal the abdominal aorta, and completes the block of the aorta above the level of the abdominal trunk by vertical clamping with the aortic clamp. Time is sought to complete definitive block above the level of the aneurysm and below the level of the renal artery as soon as possible. (3) Balloon catheter blocking method: Medical institutions with the condition can insert a post-Fogarty 8~22F aortic balloon catheter in the AAA proximal to the aorta after transbrachial or femoral artery penetration or incision, and inflate or inflate the water balloon to block the abdominal aorta to stop the bleeding. (4) Direct compression block method: The aorta proximal to the aneurysm is revealed and then compressed with fingers in the direction of the spine or with a compressor. Fingers can also be inserted through the rupture of the aneurysm towards the proximal end and over the neck of the aneurysm to stop the bleeding. At the same time, blocking forceps can also be placed or a large posterior balloon catheter can be placed to stop the bleeding. 4.The basic procedure of ruptured AAA treatment is the same as elective AAA surgery, i.e. abdominal aortic aneurysm resection and artificial vessel grafting. Some people advocate using straight artificial vessels as much as possible to reduce the operation time, but for severe iliac artery lesions, Y-type artificial vessels must be used, and PTFE without precoagulation is preferred in the choice of artificial vessels. Endoluminal treatment is also feasible for ruptured AAA. The limiting factors in these cases are the appropriate size of the abdominal aorta and iliac artery and the ability to place a suitable graft in the shortest possible time. There is usually no time to perform a CT examination and the best solution is to place an abdominal aorta-lateral iliac artery endoluminal graft, occlude the contralateral iliac artery and perform a femoral arterial bypass in order to shorten the operation and bleeding time. Although the case selection criteria and long-term outcome of ruptured AAA are still difficult to determine, the method may be beneficial to improve the clinical outcome of critically ill patients as technology advances.