Sex differences in aortic tortuosity in patients with abdominal aortic aneurysms

Objective The objective was to determine whether there is a difference in aortic tortuosity between men and women who underwent elective surgery for abdominal aortic aneurysms (AAAs) using two-dimensional computed tomography imaging. Methods A retrospective review of a prospectively maintained database of male and female patients who underwent elective AAA repair from December 2014 to December 2019 was undertaken. Maximal aortic diameter was measured on preoperative computed tomography scans, and patients were categorized into two groups (<5.5 cm and ≥5.5 cm). The degree of aortic tortuosity, defined as the maximum lateral deviation from aortic centerline on coronal views (mm), was measured and compared between men and women for each group using the Student t test. Results A total of 378 patients were included in the study. Three-hundred and five patients (81%) were male with a mean age of 75 years; 73 (19%) were female with a mean age of 76 years. The average aneurysm diameter for each group was similar. The average aortic tortuosity was greater in females for both groups. In the <5.5 cm group, the average aortic tortuosity was 16.2 mm in women and 12.7 mm in men ( P = .02). In the ≥5.5 cm group, the average aortic tortuosity was 25.2 mm in women and 15.5 mm in men ( P < .01). Conclusions In patients with AAAs, greater aortic tortuosity was seen in women than in men regardless of the AAA diameter. Further studies are needed to explore the implications of this finding on the threshold for repair and the overall management plan.