From the Guidelines
Aortic ectasia is a condition characterized by aortic dilatation of less than 50% over normal, which is less severe than a thoracic aortic aneurysm (TAA) that is diagnosed when there is at least 50% enlargement of the aortic lumen. This condition is often asymptomatic and may be discovered incidentally upon imaging for another cause 1. The normal thoracic aorta diameter varies from 3.5 to 4.0 cm at the aortic root and tapers distally to 2.4 to 2.7 cm at the level of the diaphragm, with larger diameters seen in older males 1.
Key Characteristics of Aortic Ectasia
- Aortic dilatation of less than 50% over normal
- Less severe than a thoracic aortic aneurysm (TAA)
- Often asymptomatic
- May be discovered incidentally upon imaging for another cause
- Requires monitoring as it can potentially progress to an aneurysm over time
Management and Monitoring
Management of aortic ectasia typically focuses on controlling risk factors, such as high blood pressure, through medication (e.g., beta-blockers or ACE inhibitors), cholesterol management with statins, smoking cessation, and regular imaging follow-up (usually with echocardiograms, CT scans, or MRIs every 6-12 months depending on size) 1. Patients with aortic ectasia should avoid extremely strenuous activities that dramatically increase blood pressure and should report any sudden chest, back, or abdominal pain immediately to healthcare providers.
Importance of Monitoring
The condition is concerning because progressive dilation increases the risk of aortic dissection or rupture, which are life-threatening emergencies 1. Larger aneurysms that reach >5 cm in diameter, and TAAs that increase in size >0.5 cm per year, trigger an evaluation for possible intervention due to their association with increased morbidity and mortality 1.
From the Research
Definition of Aortic Ectasia
- Aortic ectasia refers to a condition where the aorta, the main blood vessel that carries blood from the heart to the rest of the body, becomes dilated or enlarged 2.
- This condition can be asymptomatic, but it can also lead to serious complications, such as rupture or dissection of the aorta 2.
Characteristics of Aortic Ectasia
- Aortic ectasia is characterized by a maximum diameter of 25-29 mm 2.
- The annual growth rate of aortic ectasia is approximately 0.82 mm/year 2.
- The estimated risks of aortic diameters exceeding 30 mm and 55 mm in five years are 45.0% and 0.3%, respectively 2.
Risk Factors and Mortality
- Aortic ectasia carries a minimal risk of aneurysm-related lethal events during the first five years, but a similar overall mortality risk as abdominal aortic aneurysm 2.
- Cancer and cardiovascular diseases are leading causes of death in patients with aortic ectasia 2.
- Treatment with statins has been shown to reduce mortality and slow the progression of aortic stenosis [(3,4)].
- Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) may also have a beneficial effect on aortic ectasia, although more research is needed to confirm this [(5,6)].