Introduction <p>Abdominal aortic aneurysms (AAAs) pose a significant health risk, particularly due to the potential for sudden rupture, which may lead to catastrophic consequences. It is hypothesised that rupture of an AAA may cause loss of consciousness whilst driving. Many countries have implemented regulations to govern driving eligibility for individuals diagnosed with AAAs, with significant international variation in criteria and enforcement.</p> Aim <p>The aim of this paper is to examine the discrepancy in medical fitness-to-drive regulations in Ireland and the United Kingdom (UK) and compare to other international standards. An additional aim is to explore vascular guidelines and the scientific evidence for the aneurysm size threshold at which driving cessation is advised.</p> Methods <p>Driving guidelines relating to AAA from selected international jurisdictions were reviewed and compared with Irish and UK standards. Guidelines were assessed for thresholds for notification, driving restriction, repair, differences between Group 1 and 2 drivers, relicensing criteria, and other relevant regulatory features.</p> Results <p>The findings reveal significant international heterogeneity and a lack of standardisation in guidelines for Group1 drivers. Homogeneity is strong internationally for Group 2 drivers, and regulations enforce a 5.5&#xa0;cm size threshold for driving disqualification, in keeping with current guidelines for surgical repair. The scientific level of evidence for these guidelines are limited, and weak where present.</p> Conclusion <p>This current international guidance is disparate on Group 1 drivers and uniform for Group 2 drivers. This paper highlights the need for greater international consensus and justified driving policies to ensure both patient and public road safety.</p>