Talvitie M, Stenman M, Roy J, et al. - Given that mainly treated patients have been the focus of studies on intact abdominal aortic aneurysms, researchers sought to retrieve data on untreated patients and examined how untreated patients differ by gender in rupture and mortality rates. In addition, they investigated predictors for these events and evaluated gender‐specific causes of death. National registries were queried for patients ≥ 40 years diagnosed from 2001 to 2015 (n = 32,393) with intact abdominal aortic aneurysms. Of the identified patients, 60% (n = 19 569) were untreated suggesting that a considerable proportion of patients with intact abdominal aortic aneurysms in surveillance did not undergo treatment. Per findings, the healthcare system, despite surveillance algorithms, was unable to avert a high number of ruptures, especially among women. Within 5 years, ruptures occurred in 798 (9.7% women vs 6.9% men). Following factors were noted to be independently linked with ruptures: female gender, chronic obstructive pulmonary disease, age, and income. Female gender did not independently predict mortality. The third most common cause of death was rupture (11.9% women vs 8.7% men). The median time‐to‐events was 2.8 years highlighting the urgent necessity for developing more individualized surveillance.