This study clearly states that Small abdominal aortic aneurysm (AAA) surveillance intervals remain controversial and difficult to standardize. Current Society for Vascular Surgery guidelines lack quality evidence. The objective of this study was to examine patients observed in a high-volume noninvasive vascular laboratory, to determine whether current guidelines are fitting in clinical practice, and to attempt to further identify risk factors for growth. A retrospective analysis was conducted of patients who underwent at least two ultrasound examinations for AAA in the vascular laboratory during 2008 to 2018 with baseline diameter <5.0 cm. Patients’ demographics were collected. Groups were created for comparison using size criteria according to Society for Vascular Surgery guidelines. We also compared overall growth rates, specifically rapid growth (rate of at least 1.0 cm/y and size change of at least 0.5 cm), expected growth (any growth <1.0 cm/y and at least 0.5 cm from baseline), and no growth. There were 1581 patients (1232 male, 349 female) identified, with a total of 5945 ultrasound examinations.