Tortuous Aorta

A tortuous aorta means the largest artery in your body has several twists or turns that it shouldn’t. It’s often harmless. But in some cases, it can be a sign of a genetic condition that affects your blood vessels. It can also make certain surgeries harder. 

A typical aorta curves upward as it leaves your heart. It forms an arch in your upper chest. Then, it curves back down through your chest and belly. But a tortuous aorta may form an S-shape, C-shape or sharp angle at various points along this path, including the:

• Ascending aorta: The part that’s closest to your heart
• Descending thoracic aorta: The part that travels downward through your chest
• Descending abdominal aorta: The lowest segment in your belly that ends near your belly button

Symptoms of a tortuous aorta

A tortuous aorta itself has no symptoms. It’s a change to your anatomy that your healthcare provider can see on certain imaging tests. You might live your whole life without ever knowing your aorta has abnormal twists.

In some cases, like if you have a tortuous aorta due to a genetic condition, you may be at risk for an aortic dissection. This is a tear in your aorta’s inner layer. It causes symptoms like:

• Sudden, sharp and severe chest pain that can radiate or travel to your back
• Shortness of breath
• Confusion
• Dizziness
• Heavy sweating
• Sudden loss of sensation in your legs

Seek emergency care if you have these symptoms.

Tortuous aorta causes

You may develop a tortuous aorta due to:

• Age-related changes: As you get older, your aorta grows longer. But it still needs to fit in the same space. This can cause twists and turns to form, especially in your descending thoracic aorta. These changes are often mild and harmless.
• Genetic conditions: Marfan syndrome, arterial tortuosity syndrome, Loeys-Dietz syndrome and other genetic conditions can weaken the walls of your arteries, including your aorta. This makes them more likely to turn in abnormal ways.
• High blood pressure. This can damage your artery walls over time. Experts don’t know exactly how this leads to aortic tortuosity, but they know there’s a link.

Complications of this condition

A tortuous aorta can lead to complications during these procedures:

• Transcatheter aortic valve replacement (TAVR): To place the valve, your surgeon must send special tools through your aorta to get to your aortic valve. The twists raise the risk of accidental cuts or damage to your aorta. Surgeons take every precaution to avoid this.
• Thoracic endovascular aortic repair (TEVAR): A surgeon inserts a tube into your aorta to repair an enlarged area (aneurysm). A winding course can make it harder for the tube to seal in place, leading to an endoleak.

How doctors diagnose a tortuous aorta

Healthcare providers use imaging tests to diagnose these changes to your aorta. Possible tests include:

• Angiogram
• CT angiogram
• Magnetic resonance angiogram

Your provider may diagnose a tortuous aorta by accident. This can happen if you have an imaging test for another reason.

There aren’t hard and fast rules for diagnosing a tortuous aorta. Instead, providers look at the pictures of your aorta and may count the number of turns or loops. They use different scoring systems, like the tortuosity index or distance metric, to decide the severity. Your provider will help you understand what the findings mean.

How is a tortuous aorta treated?

Most people don’t need treatment for a tortuous aorta. If you have a genetic condition like Marfan syndrome, your provider will monitor it. The goal is to prevent life-threatening complications. You may need surgery on your aorta if you’re at high risk. This can repair weak or enlarged areas to avoid these serious complications.

There’s no specific treatment for a tortuous aorta that’s due to aging or high blood pressure. Your provider will help you manage heart disease risk factors. This helps protect your aorta and all your arteries. You may need to:

• Take medicine to lower your blood pressure
• Take medicines to manage issues like high cholesterol or diabetes
• Make changes to what you eat
• Move around more

When should I see my healthcare provider?

See your provider for a yearly checkup. This will let them keep an eye on your overall health and risk for age-related issues. If you have a tortuous aorta, your provider will let you know whether you need any follow-ups or further testing.

What can I expect?

A tortuous aorta may not affect your life much. But it depends on the cause. Your provider will explain what you can expect. If you’re diagnosed with a genetic condition, your provider may recommend genetic testing for your close biological relatives.