Objective To investigate the application value of 64 slice spiral CT angiography (CTA) in the diagnosis of abdominal small and medium atherosclerosis. Methods The clinical data of 52 patients with abdominal small and medium atherosclerosis were retrospectively analyzed. All patients underwent 64 slice spiral CTA. Based on volume rendering (VR), maximum intensity projection (MIP) and other post processing techniques, vessel probe (VP) was performed and the results were analyzed. Results In this group of 52 patients, arterial atherosclerotic plaques were found in 47 cases of abdominal aorta and branches, accounting for 90.38% and a total of 119 lesions were detected, including 31 cases of abdominal aortic grade 1 branches, 10 cases of abdominal aortic grade 2 branches and 6 cases of abdominal aortic grade 3 branches. VP showed markedly thickened vascular walls with blurry outlines, luminal filling defect with different degrees of stenosis; There were different degrees of calcified shadows. Aneurysm displayed outward expansion of the arterial lumen; Part of the blood vessels were tetanic and stiff. Conclusion 64 slice CTA is an effective method for diagnosis of abdominal small and medium atherosclerosis, which is of guiding significance for clinical diagnosis and treatment