Rupture of abdominal aortic aneurysm (AAA) is the 13th leading cause of death in western society and is fatal in 70–90%. In consequence, precise prediction of AAA rupture risk is essential. With the current, well established CT-morphological parameters such as maximum aortic diameter, aneurysm shape and AAA expansion, only at best the relative, but not the individual rupture risk can be determined. Hence, AAA rupture may occur unexpectedly in small aneurysms below the critical diameter limits whereas many large aneurysms may remain stable throughout patient’s lifetime, without prophylactic surgery.