From the Guidelines
A cardiothoracic surgeon or vascular surgeon, in collaboration with a cardiologist, typically manages a tortuous descending thoracic aorta. These specialists have the expertise to evaluate the condition, determine its severity, and recommend appropriate treatment, as outlined in the 2022 aortic disease guideline-at-a-glance 1. Management usually begins with regular imaging surveillance using CT scans or MRI to monitor the aorta's size and shape.
Key Considerations
- For mild cases without symptoms, watchful waiting with blood pressure control is often recommended, with medications such as beta-blockers (e.g., metoprolol or atenolol) and ACE inhibitors to lower blood pressure and reduce stress on the aortic wall.
- If the tortuosity is severe, causing symptoms or if there's significant dilation (typically >5.5 cm diameter), surgical intervention may be necessary, with the surgeon performing endovascular repair using stent grafts or open surgical repair depending on the specific anatomy and patient factors, as recommended in the 2022 guideline 1.
Treatment Thresholds
- The 2022 ACC/AHA guideline recommends repair for intact descending thoracic aortic aneurysms when the diameter is ≥5.5 cm (Class of Recommendation 1) 1.
- Regular follow-up appointments every 6-12 months are essential to monitor the condition and adjust treatment as needed, ensuring optimal management of the tortuous descending thoracic aorta and minimizing risks of morbidity, mortality, and impact on quality of life.
From the Research
Type of Doctor
The type of doctor that manages a tortuous descending thoracic aorta is a vascular surgeon. Vascular surgeons are medical doctors who specialize in the diagnosis and treatment of diseases affecting the blood vessels, including the aorta 2, 3, 4.
Treatment Options
Treatment options for a tortuous descending thoracic aorta include:
- Endovascular repair, which involves the use of a stent-graft to exclude the aneurysm from blood flow 2, 4
- Surgical exclusion, which involves replacing the affected portion of the aorta with a prosthetic graft 3
- Medical therapy, which can help prevent disease progression and may obviate the need for surgery 5
Key Considerations
Key considerations in the management of a tortuous descending thoracic aorta include:
- The degree of tortuosity, which can affect the choice of treatment and the risk of complications 6
- The presence of other diseases or conditions, such as aortic dissections or aneurysms, which can affect the treatment plan 2, 4
- The patient's overall health and risk factors, which can affect the choice of treatment and the risk of complications 4