Abdominal aortic aneurysm (AAA) is a hidden and fatal disease, but its underlying developmental mechanism remains unclear. It has been found that phenotypic switching of vascular smooth muscle cells and pyroptosis are two biological processes closely related to the appearance and progress of AAA, which may become an important theory to reveal the mechanism of AAA and provide a new direction for the diagnosis and treatment of AAA. In this review, we will discuss the phenotypic switch of VSMCs and the regulatory relationship between cell pyroptosis and AAA.