AIM: The aim of this paper was to study the characteristics of three distending small abdominal aortic aneurysms (AAAs), with an increase in maximal diameter from 5 to 5.5 cm or above.METHODS: Peak Wall Stress (PWS) in the presence and absence of intraluminal thrombus (ILT) was evaluated in 3 cases of small AAAs (5 cm), at initial presentation and after their expansion, at maximum diameters ≥5.5 cm using finite element analysis. Furthermore, AAA sac volume (Vsac), the percentage volume of ILT (ILT%) and the percentage change of Vsac (ΔV%) and ILT (ILT%) were estimated and the location of PWS was recorded.RESULTS: Two AAA expanded from 5cm to 5.5 cm in a period of 6 months after initial presentation, with increase of sac volume by 20% and 30%, respectively. The third AAA expanded to a diameter of 6.5 cm after a follow-up period of 13 months, with a subsequent increase in sac volume of 78%. The expansion of AAA max diameter did not correlate with differences in peak wall stress (PWS) values at the initial presentation, ranging from 20.5 to 21.3 Nt/cm2.CONCLUSION: PWS values cannot solely serve as a predictive tool for small AAA expansion. Small AAA expansion seem to be a multifactorial process, not solely described by PWS values but rather by a combination of mechanical, hemodynamic and biological factors.