Objective To analyse the epidemiology and trends of abdominal aortic aneurysm (AAA) in an ethnic Chinese population over a 21-year period in a representative referral institution in Hong Kong. Methods Over a 21-year period from 1975 to 1995, 533 patients with abdominal aortic aneurysms were treated in a single Vascular Surgical Unit at the Department of Surgery, Queen Mary Hospital, Hong Kong. Their characteristics, treatment and mortality were reviewed.Conclusion There is a progressive increase in the incidence of AAA in Chinese patients, in a time frame and pattern similar to that reported in the West.