In patients with abdominal aortic aneurysm (AAA) who have combined underlying disease and advanced age, conventional surgery has relatively high mortality and complications in the perioperative period. Although the long-term results have to be investigated, the mortality and complications in the perioperative period are significantly lower than those of open surgery, and this procedure is attractive to both patients and surgeons. 1. Preoperative preparation 1.1. Patient selection 1.1.1. Even for minimally invasive surgery, the patient’s heart, lung, and kidney functions should be checked before surgery to clarify whether they can tolerate anesthesia, contrast agents, and 2-3 hours of intraoperative operation. 1.1.2. Attention should be paid to whether the anatomical characteristics of the aneurysm are suitable for intraluminal repair. Current CT technology can accurately measure the various values we need, and preoperative DSA imaging is basically not required. The most important anatomical factor is the condition of the aneurysm neck. The length of the renal artery opening to the far undilated aorta needs to be at least 1 cm, and 1.5 cm is generally better, so as to ensure a larger anchorage area for the graft to maintain the stability of the main body, and endoluminal repair is not recommended for aneurysm necks less than 1 cm in length. In addition, severe calcification, angulation or wall thrombosis of the aneurysm neck may affect the overall stability of the stent, and although this is not an absolute contraindication to endoluminal repair, there is still a possibility of catastrophic complications such as endoleak, stent displacement or even dislodgement after surgery. Intraluminal repair is prudent when the angle of the aneurysm is more than 90 degrees. The condition of the iliac artery also needs to be carefully evaluated to determine whether the delivery system can safely and smoothly reach the aneurysm, and the forced passage of the stent through the iliac artery with severe twisting, stenosis, or calcification is likely to result in the failure of the procedure. It is likely to cause intimal damage to the conveyer, resulting in lower limb ischemia or even arterial rupture. 1.1.3. The patient’s general status, life expectancy, own wishes and economic conditions should be taken into consideration. Some patients may have to forgo endoluminal surgery because of their financial situation. In younger cases, such as those under 60 years of age and with good cardiopulmonary function, open surgery is recommended. 1.2. Materials and equipment In addition to the conventional C-arm, high-pressure syringe pump, various guidewire catheters and stents, the following materials are required: 1.2.1. Balloon catheter It is most often applied to expand the proximal and distal aneurysm neck after the release of the main body to make it fit tightly and reduce the possibility of stent displacement and internal leakage. In the case of stenosis of the access artery, it can also be applied to make the delivery system pass smoothly after balloon expansion. When the short-arm interface cannot be opened or is not fully dilated, the balloon catheter can be introduced through the upper limb artery for dilation, so the balloon catheter is a necessary device for AAA endoluminal surgery. 1.2.2, arterial stent Its role is similar to that of balloon, mainly used in distal branch stent expansion is incomplete, the application of balloon also difficult to achieve satisfactory results, can add bare stent to ensure the blood supply of the limb. 1.2.3.Goose neck collar, before connecting to the opposite branch stent, it is necessary to enter the main body interface with a guidewire, but the diameter of the interface is generally less than 1.5cm, surrounded by an open tumor cavity, and the proximal end has high-speed blood flow impact, so it is difficult to enter the guidewire, especially for some asymmetric tumors, there is a certain angle between the interface and the guidewire after the release of the main body, which increases the difficulty, at this time, it is possible to enter the guidewire from the main body side or the upper limb artery to the In this case, the guidewire can be inserted into the distal end of the interface from the side of the subject or the upper limb artery to the distal end of the interface. 1.2.4. Embolization of the steel ring About 30% of AAAs involve at least one side of the common iliac artery, resulting in the distal end of the stent needing to cover the opening of the internal iliac artery and anchored to the non-expanded external iliac artery, at which time the internal iliac artery needs to be embolized to prevent it from returning blood and causing endoleakage; if the contralateral internal iliac artery is intact, embolization of the unilateral internal iliac artery generally does not cause pelvic ischemia. It has been suggested that embolization of the thicker inferior mesenteric artery and lumbar artery is also required. 1.2.5, various types of catheters Various types of catheters are available for use in patients with leg difficulties, and gold mark catheters and stiffened and lengthened guidewires are necessary for this procedure. 1.2.6, always be ready to turn on the abdomen What cannot be forgotten is to always be ready to turn on the abdomen. Although the probability of this is very small, in case of emergency such as stent displacement and aneurysm rupture, experienced surgical and medical staff, vascular instruments and artificial blood vessels are needed to save the patient’s life. 2, operation method 2.1, stent main body implantation The patient is placed in the supine position, general anesthesia is usually chosen, routine disinfection of the laying sheet, according to the operator’s habit to choose from which side into the main body, take an oblique incision in the inguinal area to reveal the iliac femoral or femoral artery, which can be exposed bilaterally by two groups of surgeons at the same time, the femoral artery is suspended by vascular slings at both ends, the 5F arterial sheath is placed, the super-slip guidewire or J-type soft guidewire is introduced, and the gold marker is replaced After the angiography, the required data were carefully measured, and the stent type was selected based on the preoperative CT measurements. The positioning at the opening of the renal artery can be selected as a bony marker, which is more accurate, or the opening position can be marked on the monitor, especially for AAA with a short tumor neck. At this time, the superhard guidewire is replaced and the femoral artery is dissected transversely, and the main stent delivery system is introduced along the superhard guidewire to below the renal artery. In order to reconfirm the position of the lowermost renal artery opening, a pigtail catheter can be inserted into the contralateral femoral artery to the level of the renal artery, and the contrast agent is hand-pushed in small doses. After confirming that the stent is correct, the overlying portion is released exactly below the opening of the renal artery according to the markings on the stent, taking care to withdraw the contralateral pigtail catheter to the level of the common iliac artery. The delivery system should be systemically heparinized prior to entry. After the release of the main body, re-imaging is done to determine the presence of endoleaks and treat accordingly (balloon dilation, etc.). 2.2. Implantation of contralateral branch stent A guide wire is placed through the pigtail catheter left on the contralateral side in an attempt to enter the main body interface, as mentioned before, this step is sometimes difficult to operate, a gooseneck collar can be applied to pull out the guide wire from the contralateral side or upper limb, and then enter the delivery system through the guide wire, it should be noted that the stent should have sufficient overlap with the main body short branch when releasing, generally about 2 cm is needed, but too much overlap may cover the main body lateral branch opening It is necessary to choose the appropriate length of branch stent according to the patient and the main stent type. After the release of the stent, it is still necessary to check whether there is endoleakage by imaging, and it is necessary to pay attention to the complications of the access artery such as perforation and entrapment, which can be treated by luminal treatment with overlapping stents as early as possible. After satisfactory imaging, the vessel and incision should be sutured. There are many different clinical scenarios for stent delivery and release, and the operator must accumulate several experiences to deal with different events that occur, and a certain learning curve is needed to handle different AAA endoluminal treatment cases. 3. Postoperative management Recovery from AAA endoluminal repair is more rapid than from open surgery. The vast majority of patients have fever for 3 days to 2 weeks, but there is generally no evidence of systemic or graft infection, called post-luminal repair syndrome, and no special management is required. Because of the large amount of contrast used during the procedure, the patient’s urine output and renal function need to be tested postoperatively. Attention should be paid to the blood flow of the lower extremities, and if the internal iliac artery was surgically blocked attention should also be paid to the blood flow of the pelvic tissues and organs. Regular CT follow-up should be performed after discharge from the hospital.