Objective: To analyze the occurrence of perioperative death and severe complications of abdominal aortic aneurysm (AAA) and the preventive strategy. Methods: The clinical data of 143 AAA patients undergoing surgical treatment from January 2009 to December 2014 in Xiangya Hospital of Central South University were retrospectively analyzed. Results: In the whole group of patients, there was perioperative (within 30 d after operation) death in 6 cases (4.2%) and severe complications occurred in 20 cases (14.0%). In patients undergoing endovascular repair, the incidence of postoperative death was lower than that in patients undergoing open surgery, but the difference did not reach a statistical significance (1.3% vs. 7.5%, P>0.05), while the incidence of severe complications was significantly lower than that in the latter (6.6% vs. 22.4%, P<0.05). The incidence of postoperative cardiovascular complications in patients with preoperative concomitant coronary artery disease was significantly higher than that in patients with non-coronary artery disease (9.1% vs. 0.9%, P<0.05), but showed no significant increase in patients with hypertension (4.8% vs. 2.5%, P>0.05). Patients with other underlying diseases were not included in statistical analysis due to small number of cases. Conclusion: Endovascular repair has evident superiority to open surgery in respects of reducing perioperative death and severe complications of AAA, and in those patients with preoperative concomitant coronary artery disease, aggressive preventive measures should be taken to avoid the occurrence of cardiovascular complications.