The small abdominal aortic aneurysm is defined as an abdominal aortic aneurysm with a maximal diameter of 30-54 mm. Most patients are asymptomatic and have a low risk of rupture. However, there are still cases of small abdominal aortic aneurysm rupture in clinical practice. Once the aneurysm ruptures, the mortality rate is very high. Meanwhile, the proportion of surgical intervention during follow-up was also considerably high. At present, there are no established treatment strategies targeting the pathogenesis. So, how to carry out an adequate clinical follow-up, prediction of the risk of rupture, and timely prosthetic vessel replacement or endovascular graft exclusion are particularly important. In this paper, the authors describe the current status of clinical follow-up of abdominal aortic aneurysm and how to accurately predict the risk of rupture.