[Extract] Despite a number of large randomised trials (with more underway) the management of small abdominal aortic aneurysms remains controversial.1–3 In this issue of the European journal of vascular and endovascular surgery Vega de Ceniga and colleagues report on the growth rate of abdominal aortic aneurysms measuring !5 cm in maximum diameter followed for a mean of four and half years.4 The authors divide the patients into two groups with aortic diameters measuring 3–3.9 cm (nZ246) and 4–4.9 cm (nZ106) imaged by annual ultrasound and 6-monthly CT, respectively. The authors report that the larger aneurysms grow at over twice the rate of smaller aneurysms (4.7 compared to 2.1 mm/year) and using Kaplan–Meier analysis estimated that 56 and 82% compared to 2 and 18% of aortas reached 5 cm diameter by 2 and 5 years, respectively.4