From the Guidelines
A tortuous aorta indicates an elongated and twisted aorta, which is often a normal age-related change rather than a disease, and is generally benign, requiring no specific treatment unless complications develop, as stated in the most recent guidelines 1.
Key Points
- A tortuous aorta is a common finding in older adults, resulting from the natural loss of elasticity in the aortic wall, causing the vessel to become more curved and elongated.
- This condition is often associated with hypertension, atherosclerosis, or connective tissue disorders, but most patients remain asymptomatic.
- Regular monitoring through imaging studies may be recommended for patients with significant tortuosity, but intervention is rarely needed unless complications develop.
- The diagnosis is usually incidental, found during chest X-rays or other imaging studies performed for unrelated reasons.
- The natural aging process causes the aortic wall to lose elastin fibers and accumulate collagen, contributing to the vessel's elongation and tortuosity over time, as supported by recent studies 2, 1.
Clinical Considerations
- Patients with a tortuous aorta should be monitored for signs of complications, such as chest discomfort or difficulty swallowing, and undergo regular imaging studies to assess the severity of the condition.
- The presence of a tortuous aorta may be associated with other cardiovascular risks, such as aortic dissection or aneurysm, and patients should be evaluated for these conditions, as recommended in the guidelines 1.
- Treatment is typically focused on managing any underlying conditions, such as hypertension or atherosclerosis, and preventing complications, rather than addressing the tortuosity itself, as stated in the recent guidelines 3.
From the Research
Indications of a Tortuous Aorta
A tortuous aorta can indicate several conditions, including:
- Genetic arteriopathies, such as Loeys-Dietz syndrome and arterial tortuosity syndrome 4
- Increased risk of adverse cardiovascular events, including aortic surgery, aortic dissection, and death 4
- Aortic dilation and dissection, particularly in patients with Turner syndrome 5
- Acute type A aortic dissection (ATAAD), with studies showing a moderate correlation between ATAAD and ascending aortic tortuosity 6
Association with Aortic Disease
A tortuous aorta is commonly present in genetically mediated aortic disease 4 and can be an imaging biomarker associated with increased risk for aortic dissection and adverse cardiovascular events 5. The relationship between aortic tortuosity and disease is complex, with studies suggesting that quantification of tortuosity may augment current algorithms for determining risk in patients with aortic disease 4, 7.
Diagnostic and Prognostic Value
The diagnostic and prognostic value of a tortuous aorta is being researched, with studies investigating the use of imaging modalities such as 4D flow MRI and hybrid PET-CT to assess anatomic, hemodynamic, and molecular features of the aorta 7. The use of tortuosity indices, such as the thoracic aortic tortuosity index (ATI-D) and the aortic tortuosity index to the celiac artery (ATI-C), may help identify patients at increased risk of aortic dissection and adverse cardiovascular events 5, 6.