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MiR-501-3p, a small non-coding RNA, has been linked to vascular damage and arterial stiffness, but its role in abdominal aortic aneurysm (AAA) remains unknown. Blood exosomal microRNAs were extracted, and RNA was also extracted from tissue samples, including both the region of maximum aortic dilation and the transition zone between normal and aneurysmal tissue. The low blood miR-501-3p expression group included more AAA patients and greater size than the high group. Multivariate analysis revealed a significant association between the presence of AAA and low blood miR-501-3p (OR = 6.467, p < 0.05). In AAA tissue, miR-501-3p was lower in the maximum point compared to the border point and correlated with larger AAA sizes. All low expression cases at the maximum point had an AAA ≥ 55 mm, whereas only 9.5% of cases in the high expression group had an AAA ≥ 55 mm (P < 0.01). miR-501-3p was identified as a potential key indicator and regulator of AAA presence and expansion.