Aortic aneurysm is a progressive disease that can involve any territory of the aorta. This has ramifications on endovascular repair, because progressive dilation of sealing zones can compromise the integrity of the repair and lead to long term failure. This article describes the evidence behind and some of the predictors of progressive disease of the aorta. Knowledge of predictors of progressive disease may help prevent it from causing failure in the longterm by helping to tailor surveillance routines or have influence on initial graft design.