The patient, Liu, male, 58 years old, was admitted with “abdominal aortic aneurysm found on physical examination for 2 days”. The patient had no history of hypertension and was considered to be due to atherosclerosis, and was advised to check the patency of the carotid arteries. The intracranial blood supply was compensated by bilateral vertebral arteries and lateral branches of external carotid arteries. The aortic aneurysm was about 10 cm long and 6.7 cm in diameter, and the aneurysm neck was about 2 cm from the bilateral renal arteries, which was consistent with the preoperative diagnosis. The aneurysm neck and the tissues around the aneurysm were carefully freed, and care was taken to protect the inferior vena cava, iliac vein, renal arteries and bilateral ureters. The distal common iliac artery and the right common iliac artery were seen to be more twisted. After placing vascular blocking strips on the neck of the aneurysm and the distal common iliac artery respectively, heparin 30 mg was injected through the aneurysm, and the anesthesiologist was notified to prepare for control of lowering blood pressure. The anterior wall of the aneurysm was incised longitudinally, and a large amount of turbid sediment-like cholesterol crystalline suspension, thrombus and mechanized material was seen in the aneurysm. The anterior part of the neck of the aneurysm and the common iliac artery were circumferentially cut in the anterior half of the aneurysm respectively, and attention was paid to protect the adjacent inferior vena cava. The atherosclerosis in the common iliac artery was severe, and to prevent postoperative plaque dislodgement, the distal heart of both common iliac arteries in the aneurysmal cavity was sutured and ligated. After completion of the anastomosis, the bilateral distal iliac branches were blocked, the aortic blocking forceps were partially released, the aortic anastomosis site was checked for active bleeding, and the aortic flow was re-blocked after heparin saline flushing of the main body of the artificial vessels and the iliac branches. A longitudinal incision was made at the bifurcation of the internal and external iliac arteries on both sides of the common iliac artery, and after removing the active plaque to shape the anastomosis site, an external end-lateral anastomosis was performed with a 5-0 non-invasive suture to the bifurcated iliac branch of the 9 mm artificial vessel, and the aortic blocking forceps were partially released to completely drain the gas and blood clots from the bilateral iliac branches respectively. After again informing the anesthesiologist to prepare for elevated blood pressure, the blocking clamp was released and aortic blood flow was restored. The anastomotic sites were carefully inspected and there was no active bleeding, only a small amount of bleeding in the middle sacral artery site, which was tied with 4# silk sutures. The absence of bleeding at the lumbar artery site was reconfirmed. Absorbable gelatin sponge and hemostatic damask were placed on the anastomotic site. The small intestine was retracted in situ to confirm that there were no signs of ischemia in the colon. The artificial vessel was wrapped with sutures from the residual sac wall of the aneurysm and the retroperitoneum was sutured. After the assistants clearly palpated the bilateral dorsalis pedis artery and posterior tibial artery with strong pulsation, the instruments and accessories were counted correctly, a drainage tube was placed in the left lower abdomen, and the abdominal cavity was closed layer by layer. The whole operation was smooth, the anesthesia was stable, and the vital signs were stable. Intraoperative bleeding was about 100 ml. After awakening from anesthesia, he was returned to the ward care unit. Antibiotics, gastric mucosa protection and thrombosis prevention drugs were administered. The patient was discharged 14 days after surgery.