SUMMARY: Arterial tortuosity is a morphological variation characterized by abnormal curvatures, twists, or elongations along the course of arteries, with potential clinical implications due to its impact on hemodynamics and tissue perfusion. Although in some cases it may be considered a benign anatomical variant, multiple studies associate arterial tortuosity with cardiovascular, neurological, and microvascular diseases. The aim of this study was to systematically review and update the scientific evidence on the clinical impact of arterial tortuosity, as assessed through medical imaging, and to analyze the structural and functional mechanisms that may explain its association with cardiovascular risk factors. A systematic search was conducted in PubMed, Scopus, and Web of Science up to February 2025, following PRISMA guidelines. A total of 42 studies met the inclusion criteria. The vascular territories most frequently evaluated were coronary, cerebral, femoral, and retinal arteries, and the imaging techniques included conventional and CT angiography, MR angiography, Doppler ultrasound, and digital fundus photography. Significant associations were found between arterial tortuosity and systemic hypertension, non-obstructive coronary artery disease, ischemic cerebrovascular events, intermittent claudication, and diabetic or hypertensive retinopathies. In addition, a growing use of artificial intelligence-based strategies for the automated detection and quantification of arterial tortuosity was observed. Taken together, these findings highlight the clinical relevance of arterial tortuosity and underscore the urgent need to establish standardized criteria for its measurement, classification, and longitudinal follow-up, in order to integrate tortuosity into diagnostic and prognostic algorithms in vascular medicine.

KEY WORDS: Arterial tortuosity; Coronary arteries; Vascular imaging; Hemodynamics; Cerebral Arteries; Femoral Artery; Artificial intelligence.