Abdominal aortic aneurysm (AAA) is characterized by a localized and irreversible enlargement of the abdominal aorta, which poses a significant risk to life in the event of rupture. Currently, the primary treatment for AAA is surgical intervention, as there are no effective pharmacological therapies available to prevent or slow postoperative vascular dilation. Therefore, understanding the detailed pathogenesis of AAA and identifying effective prevention and treatment strategies is essential. This review begins by examining the pathological and molecular mechanisms involved in AAA, focusing on key research areas such as the phenotypic switching of vascular smooth muscle cells, inflammation and metabolic reprogramming. Based on a large of animal and clinical studies, this review then explores therapeutic strategies and promising drugs for AAA, including mesenchymal stem cell therapy, nanomaterial applications, and immunomodulatory interventions. The review aims to provide researchers with new ideas and directions for the prevention and treatment of AAA.