Abdominal aortic aneurysm (AAA) is one of the most serious life-threatening diseases. In recent years, with the development of treatment technology, some patients can be treated with intervention. For patients with extensive lesions that accumulate arterial openings in major organs and are not suitable for interventional treatment, surgery has also made great achievements. It is now possible to give the majority of patients the opportunity to be treated. Aneurysms are generally classified as true aneurysms, pseudoaneurysms and coarctation aneurysms. Patients with aneurysms over 5 cm in diameter have a significantly higher chance of rupture, and when rupture occurs it is extremely dangerous. Up to now, our department has performed 9 total abdominal aortic replacement surgeries. Among them, there were 6 cases of true abdominal aortic aneurysm, 2 cases of abdominal aortic coarctation and 1 case of pseudoaneurysm. All of them were operated with double-lumen tracheal intubation, right lateral recumbency and combined thoracoabdominal incision (sixth intercostal and left paramedian incision in the abdomen). During the operation, the celiac trunk artery, superior mesenteric artery, right and left renal arteries, and right and left iliac arteries (in some patients, the inferior mesenteric artery was also freed) were freed, and after blocking the above arteries, the aorta at the upper end of the aneurysm was blocked, and the aneurysm was incised, and the above arteries were anastomosed using four branches of artificial vessels. Among the 9 patients, one case could not be safely discharged from the operating table due to the emergency operation of aneurysm rupture before the operation, while the other 8 patients were successfully discharged from the hospital. This type of surgery is very traumatic, with long operating time and more intraoperative bleeding, but surgery is still the only treatment method for some patients. Adequate preoperative preparation, well-designed surgical plan, and excellent intraoperative technique can lead to a good prognosis for the patients.