Rupture of an abdominal aortic aneurysm is associated with a high risk of death. Endovascular repair results in lower perioperative morbidity and mortality than open repair, but the two methods have similar long-term mortality. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage A 76-year-old woman presents with a 2-day history of left-lower-quadrant pain. A computed tomographic (CT) scan reveals diverticulitis and an incidental 5.6-cm infrarenal abdominal aortic aneurysm. Her medical history is notable for hypertension, hypercholesterolemia, and obesity. She is a current smoker, with an 80 pack-year history. How should her case be managed? The Clinical Problem Abdominal aortic aneurysm is a segmental, full-thickness dilatation of the abdominal aorta exceeding the normal vessel diameter by 50%, although an aneurysm diameter of 3.0 cm is commonly regarded as the threshold. The natural history is characterized by progressive expansion; however, the growth rate . . .