Health organizations recently recommended one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men aged 65 to 75 who have ever smoked. This recommendation emerged from the results of a systematic review showing that AAA screening and surgical repair of large AAA leads to a decreased AAA-specific mortality in this population. Moreover, AAA screening is cost-effective. However, concerns persist about the effectiveness of AAA screening when applied in the daily practice setting, and the best care of small AAA for which research clinical trials have shown that early, elective surgery does not save lives.