The current screening and management guidelines for abdominal aortic aneurysms (AAAs) are based on maximal aortic diameter criteria. This study compared the aortic measurements between ruptured and intact AAAs to identify the prognostic markers for rupture. Patients treated for AAAs at Thomas Jefferson University Hospital from 2014 to 2021 were randomly selected from intact AAAs (iAAAs), ruptured AAAs (rAAAs), and no aortic pathology (NP) groups. Preoperative computed tomography angiography studies were retrospectively measured using Aquarius iNtuition (TeraRecon Inc, Durham, NC). The maximal diameter, length, mural thrombus volume (MTV), and Hounsfield calcification were measured from the lowest renal artery to the femoral artery. The aortic height index (AHI = maximal AAA diameter + length/height) was calculated to control for height. One-way analysis of variance, followed by Tukey’s multiple comparison tests and Pearson’s correlation, was performed using Prism, version 9.3.1 (GraphPad, San Diego, CA). Computed tomography angiography from 45 patients (age, 69.40 ± 8.28 years; 86.6% male) were measured for the iAAA (n = 19; 42.2%), rAAA (n = 16; 35.6%), and NP (n = 10; 22.2%) groups. Compared with those with iAAAs, the maximal AAA diameter (7.71 cm vs 6.19 cm; P = .022) and MTV (180.8 cm3 vs 91.79 cm3; P = .0323, Fig 1) was larger for the rAAA patients. The infrarenal aortic length correlated positively with the AAA diameter [r(43) = 0.66; P < .0001; Fig 2) and an increase in AAA diameter compared with NP (rAAA, 12.89 cm; iAAA, 13.03 cm; NP, 9.75 cm; P < .0001). The AHI was elevated in the rAAA compared with the iAAA patients (4.50 cm/m vs 3.43 cm/m; P = .0102; Fig 1). No other parameter differed between the rAAA and iAAA patients. Our study has demonstrated that the AAA diameter, MTV, and AHI are significant predictors of rupture of AAAs. Additionally, the infrarenal aortic length might be a viable prognostic marker for AAA vessel wall strength, warranting further investigation. These results will assist in identifying patients at high risk of rupture.Fig 2Abdominal aortic aneurysm (AAA) diameter vs length correlation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)