Aortic Disease

What Is Aortic Disease?

The aorta is your body's largest artery, carrying oxygen-rich blood from the heart. When your aortic valve opens and blood flows into the aorta, the aorta and its branches deliver vital nutrients to every part of your body, including the heart itself.

When your aorta is healthy, its elastic walls expand and contract easily. However, when your aorta is diseased, the areas of weak, abnormal tissue bulges or balloons out. The stress of high-pressure blood flow on this abnormal tissue, which becomes weak and thin, puts this vital blood vessel at risk of tearing or rupturing.

Thoracic aortic disease may be caused by several different conditions and may occur in both males and female of any age. When the underlying cause is genetically based, more than one family member may be affected. Thoracic aortic disease is serious because weak, fragile aortic tissue under high pressure may tear or rupture, causing life-threatening bleeding. Early detection can prevent emergencies that too often result in injury or loss of life.

Types of Aortic Disease

Aneurysm

Bulging or enlargement of a blood vessel due to weakness of vessel wall.

Dissection

A tearing of the inner lining of the aortic wall, allowing blood to enter and split the layers of the aortic wall. Blood may travel within the layers of the aorta, creating a "false" channel, sometimes called a false lumen.

Intramural Hematoma

Bleeding within the wall of the aorta, a variation of classic aortic dissection. Ulceration of atherosclerotic plaque penetrates into the aortic wall.

Symptoms

Aortic diseases often go unnoticed because patients rarely feel any symptoms. While only half of those with aortic disease complain of symptoms, possible warning signs include:

• Pain in the jaw, neck, and upper back
• Chest or back pain
• Coughing, hoarseness, or difficulty breathing

Causes and Risk Factors

Several factors increase the risk of developing an aortic aneurysm or dissection, including environmental and genetic influences.

Environmental factors that increase the chance to develop an aortic aneurysm or dissection include:

• Uncontrolled hypertension (high blood pressure)
• Smoking
• Bicuspid aortic valve
• Weight lifting
• Trauma to the aorta
• Inflammatory disease

Genetic factors also influence the risk to develop an aortic aneurysm or dissection. Thoracic aortic aneurysm and/or dissection (TAAD) can have three different types of genetic risk:

• Familial TAAD
• Syndromic TAAD
• Sporadic TAAD

Diagnosis

Diagnostic testing is the first step in establishing a treatment strategy. A high degree of accuracy in the performance and interpretation of these tests is particularly critical in the evaluation of aortic disease:

• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• X-Rays
• Echocardiogram (ECHO)

Treatment

Medical Treatment

Medical treatment and lifestyle changes are specified for each individual and will include blood pressure optimization and lifestyle recommendations. Blood pressure medications, such as beta-blockers, ACE inhibitors, ARBs and calcium channel blockers, are commonly prescribed. However, use of diuretics may be beneficial in patients who are prone to weight gain as a result of water retention. Generally, an optimal systolic blood pressure range prior to surgery is between 105 and 110 during normal activity.

Lifestyle recommendations address diet, exercise and smoking cessation. It is very important that those with aortic disease do not smoke either actively or passively. A diet low in fat and carbohydrates and high in fiber and protein is recommended. Exercise is generally extremely helpful for aortic aneurysm patients, and they are encouraged to be active. Usually power walks of 15 to 30 minutes two to three times daily are recommended. However, heavy lifting, which puts pressure on the aorta, is prohibited.

Surgical Treatment

When the risk of aortic dissection or rupture is greater than that associated with surgery, elective surgery is offered to replace the diseased section of the aorta with a Dacron graft. If necessary the aortic valve may also be either repaired or replaced.

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