Abdominal aortic aneurysm (AAA) is an important cause of mortality in older adults. Most AAAs are asymptomatic and screening programs have been introduced to identify AAAs at an early stage in some countries. There is currently no accepted therapy for early stage or small AAAs, which are frequently identified by such programs. In this review, we discuss work underway to identify targets for medical treatments to limit progression of small AAAs. Specifically we discuss studies, which have examined the potential of targeting inflammation, proteolysis, the renin-angiotensin system, the coagulation system and sex hormones as approaches to limiting AAA pathogenesis. As yet, none of the treatment targets have translated into an agent, which can effectively reduce AAA progression in clinical practice.