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What Is a Tortuous Aorta?

Mary McMahon
Updated Mar 03, 2024
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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.

What is the Treatment for Tortuous Aorta?

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.

Surgical Options

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).

Non-Surgical Options

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:

  • allergic reaction to contrast dye
  • blood clots
  • heart attack
  • irregular heartbeat (arrhythmia)
  • kidney problems
  • perforation of the artery wall
  • stroke

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.

Is a Tortuous Thoracic Aorta Dangerous?

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.

What are the Symptoms of a Tortuous Aorta?

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

  • anxiety
  • depression
  • fatigue
  • pain
  • stress

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. 

Self-Care for People With Tortuous Aorta

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.

FAQ on Tortuous Aorta

What is a tortuous aorta and how common is it?

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.

What are the symptoms of a tortuous aorta?

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.

Is a tortuous aorta dangerous?

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.

How is a tortuous aorta diagnosed?

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.

What treatment options are available for a tortuous aorta?

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.

The Health Board is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Mary McMahon
By Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a The Health Board researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

Discussion Comments

By anon302572 — On Nov 10, 2012

My aunt died at 52 with this and now I have the same thing.

By anon296368 — On Oct 11, 2012

Just wondering since I was recently diagnosed with a "twisted aorta" at age 58 (female). I was hearing that it can be hereditary. Is a "twisted aorta" nothing to worry about? Wound up in the ER that day due to a gastric flu virus that increase my BP, even after taking my meds that am. Felt pretty awful and couldn't distinguish the difference. Thanks!

By anon277615 — On Jun 30, 2012

I had a chest e-ray and it showed I have a thoracic aorta slightly tortous. Is this bad?

By anon189042 — On Jun 22, 2011

I had X-rays and the radiologist suggested a possible abdominal aneurysm and possible hernia on the diaphragm. He was pretty smart from just an X-ray. He suggested a CT scan to look at these. The CT scan's conclusion? Who can understand all the terminology? It is now believed I may have a twisted aorta.

I do not care what it is at this point. I just cannot stand the pain anymore. It is in my chest, through my back and into my shoulders. Yes, we did do all the heart studies as this is what my PCM was worried about. We will see see the endo dude today and hope he gets down my throat soon.

By pajesseson — On Apr 03, 2011

my xray taken after a car accident showed "tortuous aorta. there is superimposed densities along the right heart border, which could represent left atrial enlargement."

Any idea what this may mean? I just read it and have no idea.

By bjim42 — On Jan 26, 2011

I was diagnosed with an "unusually" tortuous aorta when I was 40 years old.

I also have a mild Mitral Valve Prolapse which causes palpitations which cause me to cough and

stop until it passes.

I am "used" to them, but I was more worried about the possibility of hardening or plaque in the aorta.

Otherwise my health is OK and I am 58 now.

By closerfan12 — On Jul 29, 2010

@EarlyForest -- Sometimes tortuous aortas can indirectly cause abdominal aortic aneurysms, like pharmchick78 was talking about.

Since a tortuous aorta is abnormal, sometimes the wall of the aorta can be weaker, leading to an aortic aneurysm, or, worst case scenario, an aortic aneurysm rupture.

Luckily, most people find out in a much easier way, usually by chance on an MRI or other unrelated test.

By EarlyForest — On Jul 29, 2010

Wow -- that sounds really scary, particularly if you can live with one and not know it for so long!

What would be some situations where you might accidentally find out you had one?

By pharmchick78 — On Jul 29, 2010

A tortuous aorta can sometimes be confused with an abdominal aortic aneurysm, so doctors should be particularly wary when a patient presents with abdominal aortic aneurysm symptoms.

The two may be difficult to distinguish even in imaging studies, however, the borders of a tortuous aorta are usually very clearly distinguished.

By being aware of this, both doctors and surgeons can avoid potentially deadly abdominal aortic aneurysm complications.

Mary McMahon

Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a...

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