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Both Small and Large Non-aneurysmal Distal Aortic Diameters are Associated with Limb Events in Patients with

Netanja I Harlianto1, Pim A de Jong1, Frank L Visseren2

  • 1Department of Radiology, University Medical Centre Utrecht and Utrecht University, Utrecht, The Netherlands.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|May 27, 2026
PubMed

Insights

A small distal aortic diameter is linked to adverse limb events and mortality in patients with vascular disease. Both small and large diameters pose risks, with a U-shaped relationship observed in men for limb events.

Area of Science:

  • Vascular Medicine
  • Cardiovascular Physiology
  • Epidemiology

Background:

  • Established cardiovascular disease patients face risks of arterial events.
  • Distal aortic diameter's role in adverse outcomes requires further elucidation.

Purpose of the Study:

  • To investigate the association between distal aortic diameter and major adverse limb events (MALE), major adverse cardiovascular events (MACE), and mortality.
  • To explore sex-specific relationships between aortic diameter and vascular events.

Main Methods:

  • Prospective cohort study of 8,463 patients from the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease.
  • Distal aortic diameter measured via ultrasound; exclusion of diameters > 3 cm.
  • Sex-stratified multivariable Cox proportional hazard models with restricted cubic splines analyzed outcomes over a median of 10.1 years.

Main Results:

  • A U-shaped relationship between aortic diameter and limb events/MALE was observed in men.
  • In women, smaller aortic diameters were associated with limb events, but not MALE.
  • Larger aortic diameters correlated with increased all-cause mortality, MACE, and vascular death.

Conclusions:

  • Non-aneurysmal distal aortic diameters are associated with adverse limb events and mortality in patients with established vascular disease.
  • Sex differences exist in the relationship between aortic diameter and vascular outcomes.
  • Both small and large distal aortic diameters present risks, highlighting a U-shaped association for limb events in men.
Abstract

Keywords:
Abdominal aortaCardiovascular eventsDiameterPeripheral artery diseasePrognosisUltrasound

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