To investigate the geometry of the aortoiliac (AI) segment and its correlation with sex, age, and cardiovascular (CV) risk factors. Abdominal and pelvic CTA/MRA scans of 204 subjects (120 males; median age: 53 IQR, 27-75 years) without AI steno-occlusive disease or scoliosis were retrospectively analyzed. The participants were enrolled consecutively, ensuring the representation of each age decade. An in-house written software was developed to assess AI elongation using the tortuosity index (TI) and absolute average curvature (AAC). Aortic bifurcation angle, common iliac artery (CIA) take-off and planarity angles, bifurcation asymmetry, and deviation from optimal bifurcation were calculated and evaluated. Demographic data, CV risk factors, and medical history were collected from electronic health records. The elongation of the iliac arteries was more pronounced in males (TI: left CIA, = 0.011; left EIA, < 0.001; right CIA, = 0.023; right EIA, < 0.001; AAC: left EIA, < 0.001; right EIA, = 0.001). Age significantly influenced TI and AAC in all AI segments (all < 0.001), but was also positively associated with the aortic bifurcation angle ( < 0.001), both CIA planarities (left, < 0.001; right, = 0.002), aortic bifurcation asymmetry ( = 0.001), and radius discrepancy ( < 0.001). Significant positive correlations were found between infrarenal aortic TI/AAC and chronic kidney disease (CKD) ( = 0.027 and = 0.016), AAC of both CIAs and hypertension (left, = 0.027; right, = 0.012), right CIA take-off angle and CKD ( = 0.031), and left CIA planarity and hyperlipidemia ( = 0.006). Sex, age, and CV risk factors have a significant effect on the geometry of the AI segment.