Reference Diameters of the Abdominal Aorta and Iliac Arteries in Different Populations

Aortic and iliac artery aneurysms are potentially fatal conditions requiring precise timing for intervention. Current guidelines for repair, including those from SVS, ESVS, and ACC/AHA, rely on fixed diameter thresholds primarily derived from Western populations. However, growing evidence shows that both aortic and iliac dimensions vary significantly among racial and ethnic groups. East Asian individuals generally present with smaller baseline vessel diameters and may be at risk of rupture at smaller sizes, while African American and Hispanic populations exhibit distinct remodeling patterns and risk profiles. This narrative review synthesizes the current literature on variations in aortic and iliac artery diameters, aneurysm prevalence, and rupture risk across racial groups. It examines the limitations of universal thresholds for repair, highlights the underrepresentation of non-Caucasian populations in early imaging registries, and introduces alternative, population-specific definitions of aneurysmal disease.