What Is a Tortuous Aorta?

The term “tortuous aorta”, a condition where the aorta twists or winds in an unusual pattern, may seem alarming, but it often exists without causing harm. According to a study published in the Journal of Vascular Surgery, the prevalence of a tortuous aorta increases with age, affecting approximately 12% of the population over 65 years old. 

While many individuals with this anatomical variation live symptom-free, it's crucial to monitor for potential complications. Advanced imaging techniques, such as CT angiography, provide detailed insights into aortic structure, ensuring that any associated risks are identified and managed proactively. Understanding the nuances of a mildly tortuous aorta can help patients navigate their health with confidence.

The aorta is the largest blood vessel in the body. It carries freshly oxygenated blood out of the heart so that it can be distributed to the circulatory system. In most people, the aorta follows a relatively straight path, but in people with tortuous aorta, the vessel may be twisted or distorted. This can cause blockages in blood flow, leading to medical complications as a result of poor circulation.

Individuals with this condition can be at risk for high blood pressure caused by the interruption to their blood flow, and they can also experience atherosclerosis, in which the vessels are lined with a layer of plaque which impedes the movement of blood through the vessels. Tortuous aorta has also been implicated in some cases of pain caused by a displaced esophagus, as the twistings of the vessel can actually push the esophagus out of position.

When imaging studies are used to identify a tortuous aorta, they can provide information about the severity of the abnormality and the condition of the vessel. If deposits are present or the vessel appears to be hardening, steps may need to be taken before the patient experiences the development of serious complications. In other instances, the abnormality may simply be something which the doctor would recommended keeping an eye on, with no action being taken unless a need for it became apparent.

Having a tortuous aorta is not necessarily a cause for concern, but patients should make sure that it is noted in their medical charts because it may become relevant during treatment. In addition, surgeons usually like to know ahead of time about unusual anatomical features in their patients, and forewarning about an abnormal aorta is a good idea. The surgeon or surgical team may want to take special steps to protect the health of the patient.

Some people live their entire lives with the condition and never experience ill effects. It is something that should be monitored, however, because of the risks it poses. As long as it is not affecting a patient's life, a physician will usually recommend that it be left alone. On the other hand, if a patient is experiencing symptoms or the condition may cause complications in an unrelated procedure, there are a few options available.

The most common treatment for tortuous aorta is known as a bypass graft repair. This is similar to other types of bypass surgeries: a plastic tube (the graft) is inserted into the normal parts of the artery, literally bypassing the affected section of the aorta.

A second surgical treatment is a resection with end-to-end anastomosis. In this procedure, the twisted or narrowed section of the aorta is simply removed. Afterward, the two ends are reconnected (this is the actual anastomosis).

A less invasive treatment is balloon angioplasty. In this procedure, the physician uses a catheter to insert a small balloon into the affected part of the artery. When inflated, the balloon forces open the constriction. Once this is done, a stent, or small mesh tube, to maintain the opening.

One of the great advantages of balloon angioplasty is that it is performed as an outpatient procedure, requiring only local anesthesia. However, some medical experts question its long-term effectiveness.

There are also a few risks involved with balloon angioplasty. One of these is restenosis, a condition in which the artery narrows again, requiring the treatment to be repeated. Other risks include:

Scientists have determined that many cases of tortuous aorta are genetic. The condition has been traced to a mutation in the SLC2A10 gene ( a glucose carrier). The gene is autosomally recessive, meaning that the patient must have two copies of the gene in order for tortuous aorta syndrome to develop. It is too soon to tell if this knowledge will eventually lead to a cure, however. Another contributing factor is the degeneration and calcification of elastin, a protein that keeps organs resilient and flexible. Some research suggests that applying aluminum ions may help to reduce elastin calcification.

As explained earlier, a tortuous aorta is not immediately life-threatening, and many people are hardly aware they have the condition. However, it is a risk factor for developing an aortic aneurysm, in which the artery wall becomes weakened and in danger of bursting.

Unlike a tortuous aorta itself, an aneurysm can be very dangerous. An aneurysm is often described as a ticking time bomb; slow growing, it can be asymptomatic for years before it bursts.

Most other health dangers associated with a tortuous aorta stem not from the condition itself, but rather from reduced blood flow and its impact on adjacent organs, such as compression. This can be a serious problem when the twisted aorta exerts pressure on the esophagus, leading to breathing difficulties and chronic chest pain. 

Because an arterial kink restricts blood flow, hypertension (high blood pressure) can result. The reduced blood flow can also lead to muscular fatigue. Generally, if a patient is otherwise in good health, a tortuous aorta is not a serious problem. It can exacerbate other cardio-vascular issues, however.

Tortuous thoracic aorta is also frequently seen in elderly patients, in whom the cause is mild cases of atherosclerosis.

Most physical symptoms of tortuous aorta are so minor, most people with the condition hardly notice it. Symptoms that patients commonly report include:

Other symptoms occur in patients with a tortuous aorta-related aneurysm. As the condition worsens, patients may find themselves experiencing chest and/or back pain, coughing and hoarseness, hypotension (low blood pressure), breathing difficulties, and even loss of consciousness. A person suffering from tortuous aorta who experiences these symptoms should get to an emergency room at the earliest opportunity, especially if there is a family history of aneurysm. 

It is possible to live a normal life in spite of having tortuous aorta, or even an aneurysm. The key is avoiding things that may cause the problem to become worse. Avoid tobacco, limit alcohol consumption, watch LDL levels (the "bad" cholesterol) and avoid situations that increase stress and blood pressure levels.

A tortuous aorta is a condition where the body's main artery, the aorta, becomes twisted or has additional curves. It's not a disease but rather a structural irregularity that can occur due to aging, high blood pressure, or other factors that affect the elasticity of the blood vessels. While exact prevalence rates are not well-documented, it is more commonly observed in older adults due to the natural aging process of the vascular system.

Many individuals with a tortuous aorta may not experience any symptoms, especially if the condition is mild. However, if the aorta is significantly twisted, it can lead to symptoms such as chest pain, back pain, shortness of breath, or difficulty swallowing. These symptoms occur due to the aorta pressing on surrounding structures or because of reduced blood flow. If you experience these symptoms, it's important to consult a healthcare professional.

A tortuous aorta can potentially be dangerous if it leads to complications such as aortic aneurysms or dissections, which are serious conditions that can be life-threatening. However, not all cases of a tortuous aorta result in these complications. The risk depends on the severity of the tortuosity, the presence of other cardiovascular conditions, and individual health factors. Regular monitoring by a healthcare provider is essential for managing the risks associated with a tortuous aorta.

A tortuous aorta is typically diagnosed through imaging studies such as chest X-rays, echocardiograms, CT scans, or MRI. These tests allow doctors to visualize the shape and condition of the aorta and assess the extent of the tortuosity. In some cases, the condition may be discovered incidentally during imaging for other reasons. If a tortuous aorta is suspected, a cardiologist will evaluate the findings and determine the need for further investigation or treatment.

Treatment for a tortuous aorta depends on the severity of the condition and whether it's causing symptoms or complications. In many cases, no treatment is necessary, and the focus is on managing risk factors such as high blood pressure or atherosclerosis. Medications may be prescribed to control these conditions. In severe cases, surgical intervention may be required to repair or replace the affected section of the aorta. Regular follow-up with a healthcare provider is crucial to monitor the condition over time.