Men and women are different, even with respect to blood vessels. Gender-specific differences concerning vascular pathologies have not been given much consideration so far. However, with respect to clinically relevant vascular pathologies, there are obvious characteristics in the comparison of gender in terms of epidemiology, prevalence, clinical manifestation, therapy outcome and hence indications for treatment. Vascular disease is more frequent in men and has a later onset in women. The getABI study revealed a higher absolute 3-year mortality in men than in women. The relative 3-year mortality (comparison with/without arterial occlusion) was higher in women than in men in terms of cardiovascular and cerebrovascular death. The disease courses are also different, insofar as women for example have a higher complication rate after aortic dissections, both in the spontaneous course and after treatment. In the long term after 5 years, women have a higher mortality rate following surgical treatment of an abdominal aortic aneurysm. The higher incidence of comorbidities in women is considered to explain this difference. If appropriate, women must be monitored longer in intensive care after high-risk operations, which include interventions on the aorta. Women with carotid stenosis are less likely to suffer a stroke. However, they only benefit from surgery during the first 2 weeks (for men 12) after the initial symptoms. Moreover surgery at asymptomatic status has less protective effect regarding female patients. The gender specificity of the pharmacokinetics of relevant medications and their influence on the results of vascular surgery has been underestimated up to now. In future, more emphasis must be given to these differences and they must be taken account of in decisions as to whether or not operative and interventional treatments are indicated and in the intensity and duration of patient monitoring after such treatment.