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Female Sex With Statistically Significantly Smaller Aortoiliac And Femoral Arteries Than Male, Implications For Future Pad Outcomes Studies
Amy Liu, MacKenzie Lee, MD, Carlos Bechara, MD, Bernadette Aulivola, MD, Lorela Weise, MD, Lindsey Korepta.
Loyola University Medical Center, Maywood, IL, USA.

Introduction: Previous studies have demonstrated discrepant arterial sizes between sexes in aneurysmal populations. Due to historical underrepresentation of females in PAD outcomes studies, there is a lack of consensus on treatment. We set out to first quantify arterial sizes between sexes in an all-comer population to then investigate this in PAD.
Methods: We conducted a retrospective review of 108 male and 108 female BMI-matched patients with computed tomography (CT) angiograms. CT scans were scored for abdominal aorta (AA), common iliac (CIA), and common femoral (CFA) outer diameters. Abdominal aortic and iliac aneurysms were excluded from analysis. Multivariate analysis-of-covariance models were used to evaluate AA, CIA, and CFA area as dependent variables.
Results: AA, CIA, and CFA area were significantly larger in males than females (p<0.001) despite similar BMIs (p=0.658) and vascular comorbidities (Table 1). The data for each vessel was then divided into four quartiles, with women having smaller vessels in all arteries (Table 2). As AA area increased, CIA and CFA increased (p<0.001). On multivariate analysis, male gender was positively correlated with larger AA, CIA, and CFA with odds ratios of 6.110, 2.645, and 3.770 respectively. Weight, diabetes, and prior smoking were negatively correlated with vessel area, while current smoking was negatively correlated with AA and CIA but not CFA.
Conclusions: In all-comers, females have smaller arteries than males. This remains true even when controlling for BMI and other vascular comorbidities. Previously demonstrated in aneurysm patients, we want to investigate this relationship further in PAD and clinical outcomes.
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