BACKGROUND: Screening for abdominal aortic aneurysm (AAA) in elderly men reduces aneurysm related mortality. AAA is commonly defined as an infrarenal aortic diameter (IAD) of ≥30 mm, which is based on the definition of an arterial aneurysm as a focal dilation of 150% or more compared to the expected diameter of about 20 mm. The IAD has been shown to correlate to body surface area (BSA). The aim of this study was to investigate the possibility to use an individualized AAA-criteria by using a BSA-based model to refine the screening for AAA. METHODS: We conducted an observational single center cohort study of 25 236 65-year old men invited to AAA screening in Malmö, Sweden 2010-2015. Out of the 19 738 (78.5%) attendees, 14 846 (58.8%) completed a health questionnaire including height, weight and smoking habits. Linear regression analysis was performed between BSA and IAD, taking smoking habits into account. This regression was used to calculate the predicted IAD for each individual according to their BSA. RESULTS: There was a significant correlation between BSA and aortic diameter, rho =0.26 (95% CI: 0.25, 0.28). AAA defined as an IAD≥30 mm was found in 226 men (1.5%) whereas AAA defined as ≥150% larger IAD than predicted according to the individual BSA was found in 299 men (1.9%), a relative difference in AAA detection rate of more than 30% (P<0.001). CONCLUSIONS: We have found a statistically significant correlation between BSA and IAD in a homogenous screening population that could have clinical implications. In men with low BSA, IAD <30 mm might still be ≥150% larger than predicted according to BSA, whereas in men with high BSA, IAD≥30 mm might not be ≥150% larger than predicted. Further follow-up of these subjects is planned to investigate if the first group have an "aneurysm-in-formation," challenging the diagnostic criteria for AAA.