A 51-year-old male patient in Changzhou, who usually felt in good health, went to an urban hospital on June 23 with no apparent reason for epigastric discomfort and nausea, and did not improve after symptomatic treatment. The next day at noon there were several nausea, vomiting, fainting, and increased abdominal pain on the left side, and again to the hospital when the CT examination was performed, it was found that Bai was suffering from a ruptured abdominal aortic aneurysm. The condition was critical, and Bai was immediately transferred to the vascular surgery department of the First City Hospital. When I saw him, a hematoma the size of a rugby ball had appeared in his abdominal aorta, and blood had accumulated in the thoracic and abdominal cavities. In the evening of June 24, with the close cooperation of the Department of Anesthesiology, the ruptured abdominal aortic aneurysm was successfully removed and a 20-cm bifurcated artificial blood vessel was replaced, and 3,000 ml of blood was transfused during the operation, which saved Bai from death. After careful medical treatment and care to overcome complications such as acute respiratory distress syndrome, Bai was recently discharged from the hospital. The rupture of abdominal aortic aneurysm is very dangerous, the onset of serious, easy to misdiagnose and mistreat when first diagnosed, many patients are not so lucky as Bai, often before a clear diagnosis will die due to haemorrhage. With the advent of an aging population and a change in diet, the incidence of aneurysms in China, especially abdominal aortic aneurysms, is on the rise. Statistics show that the incidence of abdominal aortic aneurysm is about 8.8% in people over 65 years old. Many patients suddenly rupture their aneurysms without any symptoms and die of hemorrhage, with a mortality rate of over 90%. Therefore, the medical profession has called aneurysm as a “time bomb” in the body. Our famous geologist Li Siguang and the great physicist Albert Einstein both left this life due to ruptured abdominal aortic aneurysm. Readers must have many questions in their minds: what kind of disease is abdominal aortic aneurysm in the end? Why is it so dangerous? Is there any way to detect it early? What are the clinical manifestations of abdominal aortic aneurysm? Abdominal aortic aneurysm cannot heal on its own, and if left untreated, it often ruptures and bleeds easily, leading to death. Therefore, clarifying the clinical manifestations of abdominal aortic aneurysm is the key to early diagnosis of the disease. The clinical manifestations of the disease mainly include: 1. A pulsatile mass in the abdomen. Most patients can find a pulsating mass around the umbilicus and in the left mid-upper abdomen, accompanied by tremor and vascular murmurs. 2. Pain. Most patients have only mild discomfort or distension in the abdomen, but when the tumor compresses the spinal nerve roots, there will be obvious pain in the low back. If severe abdominal pain or low back pain suddenly appears, it is a sign that the tumor has involved the blood supplying arteries in the abdominal cavity or caused rupture and bleeding of retroperitoneal vessels. 3. Compression of adjacent organs. If the tumor compresses the duodenum and proximal jejunum, it may cause gastrointestinal symptoms; if it compresses the ureter, it may lead to urinary tract obstruction; and a few patients may have obstructive jaundice because the tumor compresses the common bile duct. 4.Arterial embolism. If the thrombus inside the aneurysm cavity is dislodged, it can cause acute embolism of abdominal aortic branches, such as mesenteric artery embolism and lower limb artery embolism, and even cause ischemic necrosis of the corresponding parts. 5. Aneurysm rupture. This is the most dangerous symptom for patients with abdominal aortic aneurysm. Rupture of the aneurysm can lead to massive bleeding, and such patients often die of hemorrhagic shock within a short period of time. The irregular geometry and thickness of the vessel wall within the aneurysm lumen slows blood flow and is often accompanied by thrombosis, where the thrombus adheres to the vessel wall. The adherent thrombus is sometimes dislodged to produce an arterial embolism. In addition, aneurysms can become infected. Once infection has occurred, the symptoms are exacerbated and will make the aneurysm more likely to rupture. Aneurysms are caused by atherosclerosis, infection, necrosis of the middle layer of the artery, or congenital factors that cause the arterial wall to lose its normal structural integrity and to expand and deform locally under the action of intra-arterial blood pressure, to the point of rupture, resulting in instantaneous hemorrhage and death. The abdominal aorta is one of the largest arterial vessels in the body, and abdominal aortic aneurysm is a limited bulge caused by lesions in the arterial wall, not a tumor in the usual sense. Abdominal aortic aneurysm can be classified according to its etiology: 1. True aneurysm: atherosclerosis is the main factor, due to the deposition of lipids in the arterial wall, forming atheromatous plaques and calcium deposits, causing the artery to lose elasticity, and under the impact of blood pressure, the aneurysm body is progressively enlarged. 2.Plaque aneurysm: Cystic necrosis or progressive degenerative lesion in the middle layer of artery, which may be related to old age, specific inflammation and metabolic abnormalities, etc. It is a systemic lesion. 3.Pseudoaneurysm: It starts from trauma, direct or indirect violence (e.g. shrapnel, stabbing), penetrating trauma that ruptures and disconnects the artery, surrounded by surrounding soft tissue and forms a pulsating hematoma. How to rule out time bomb early? When a suspected aneurysm is detected, a color Doppler ultrasound should be done promptly to detect the size of the aneurysm and the presence of atherosclerosis and attached thrombus in the wall. This test is especially indicated for early detection of abdominal aortic aneurysms below the renal artery. Abdominal aortography and CT examinations can help diagnose and determine the size and extent of the aneurysm. Abdominal aortic aneurysms are not curable with medications and surgery is the only effective treatment for aneurysms. When is the best time to operate? Domestic literature reports that the percentage of ruptures occurring when the maximum diameter of the aneurysm is greater than 4 cm is significantly higher. Therefore, the current standard for surgical intervention is 5 cm. However, even in small aneurysms, there is a possibility of acute rupture. The rupture of abdominal aortic aneurysms is directly related to the size of the aneurysm diameter. Studies have shown that the incidence of rupture is 10% for diameters less than 4 cm, 30%-50% for diameters greater than 5 cm, and 80% for diameters greater than 10 cm. Traditional abdominal aortic aneurysm surgery uses general anesthesia and a large incision in the middle of the abdomen, which is a very traumatic and risky surgical method with a long recovery time. In our hospital, we have the technique of transvascular internal placement of abdominal aortic aneurysm stent, which requires only a small incision at the root of the thigh, and under local or semi-body anesthesia, a stent is implanted into the blood vessel to block the diseased aneurysm from the normal blood vessel for treatment purposes. The patient does not need to be admitted to the intensive care unit (ICU) and can eat or get out of bed on the day of surgery.