Conditions

Aorta

Anatomical depiction of the aorta

The aorta is the body's largest artery, carrying oxygenated blood from the heart to every major organ system. Aortic diseases — including aortic aneurysm, aortic dissection, and inflammatory aortopathies — are among the most dangerous cardiovascular conditions, frequently developing silently before presenting as life-threatening emergencies. Early detection through screening and specialist surveillance is the most effective strategy to prevent catastrophic outcomes.

Aortic Aneurysm

An aortic aneurysm is a localised dilation of the aortic wall to more than 1.5 times its normal diameter, caused by progressive weakening of the vessel wall. Aneurysms most commonly occur in the infrarenal abdominal aorta (abdominal aortic aneurysm, AAA) or the thoracic aorta (thoracic aortic aneurysm, TAA). Most aneurysms are asymptomatic and discovered incidentally on imaging. Rupture — the principal danger — carries a mortality rate exceeding 80%, making elective repair at appropriate size thresholds essential. Current guidelines recommend intervention for AAA exceeding 5.5cm in diameter, or smaller aneurysms with rapid expansion or symptoms.

Aortic Dissection

Aortic dissection occurs when a tear in the inner aortic wall (intima) allows blood to track between the vessel layers, creating a false lumen. It presents with sudden, severe tearing chest or back pain and represents a vascular emergency with high early mortality. Classification is clinically critical: Type A dissection involves the ascending aorta and requires emergency surgical repair. Type B dissection involves the descending aorta only and is typically managed medically with aggressive blood pressure control, with endovascular repair (TEVAR) reserved for complicated cases involving malperfusion, rupture, or rapid expansion.

Other Aortic Conditions

• Coarctation of the aorta is a congenital narrowing — typically near the ductus arteriosus — causing upper body hypertension and reduced lower limb perfusion. It is managed with balloon angioplasty, stenting, or surgical repair depending on anatomy and age.
• Inflammatory aortopathies — including Takayasu's arteritis and giant cell arteritis — cause vessel wall inflammation, stenosis, and aneurysm formation. Diagnosis requires inflammatory markers, cross-sectional imaging, and in some cases PET-CT to assess disease activity.

Risk Factors

Key risk factors for aortic aneurysm include smoking, hypertension, hyperlipidaemia, advanced age, male sex, and a family history of aortic aneurysm. Connective tissue disorders — Marfan syndrome, Loeys-Dietz syndrome, and Ehlers-Danlos syndrome — predispose to thoracic aneurysm and dissection at younger ages, often requiring earlier intervention thresholds. Bicuspid aortic valve is associated with accelerated thoracic aortic dilation and warrants dedicated surveillance imaging.

Diagnosis & Surveillance

Aortic ultrasound is the primary screening tool for AAA — non-invasive, radiation-free, and highly accurate for abdominal aortic measurement. CT aortography provides definitive anatomical assessment for treatment planning, including aneurysm morphology, branch vessel involvement, and endovascular suitability. MRI aortography is preferred for ongoing surveillance in younger patients and connective tissue disorders to minimise cumulative radiation exposure. Once an aneurysm is identified, regular surveillance imaging at defined intervals monitors growth rate and determines optimal timing for intervention.

Treatment

• Endovascular Aneurysm Repair (EVAR/TEVAR) is the preferred approach for anatomically suitable abdominal and thoracic aneurysms — deploying a stent graft via catheter through groin access, avoiding open surgery and allowing rapid recovery.
• Open surgical repair remains the standard for complex anatomy, connective tissue disorders, or where endovascular access is unsuitable. It involves replacement of the diseased aortic segment with a prosthetic graft.
• Medical management with blood pressure optimisation, statin therapy, and smoking cessation slows aneurysm growth and reduces cardiovascular event risk in patients under surveillance.

When to Seek Urgent Care

Sudden severe tearing pain in the chest, back, or abdomen — particularly with collapse, limb weakness, or pulse discrepancy between arms — requires immediate emergency assessment. Call 995 without delay. Do not wait to see if symptoms resolve.

Diagnosed with an aortic aneurysm, referred for aortic surveillance, or concerned about aortic disease? Dr. Peter Chang consults at Paragon Medical Centre, Orchard Road. Book a specialist assessment today.