Embolizing (Shaggy) Aorta
An embolism is an obstruction in a blood vessel, often a blood clot that becomes caught while traveling through the bloodstream. When an embolism develops from degenerative material (atheroma), or blood-clotting material (thrombus) develops from a blood vessel, this is known as embolizing, and it can travel to other areas of the body through the bloodstream and limit or block the blood flow to that area if it becomes lodged.
The aorta, the largest artery in the body, provides oxygen-rich blood throughout the body and can produce an embolism when it is diseased and calcified. The term "shaggy aorta" comes from how the aorta looks on CT scans and angiograms due to its diseased and degenerating state.
Symptoms related to shaggy aorta syndrome can vary depending on the location of the embolism and the degree of blockage in the blood flow. Patients with this condition may experience one or more of the following symptoms:
- Severe pain in the leg or arm
- Severe abdominal pain
- Blood in the urine
- Blood or mucus in the stool
- Progressive kidney failure (renal failure)
- Bowel tissue death (bowel infarction)
Embolisms from the aorta can travel to the following areas of the body with these possible effects:
- Brain — causing stroke
- Visceral arteries — causing abdominal pain due to narrowed arteries in the intestines (intestinal ischemia)
- Renal arteries — causing flank pain and blood in the urine (hematuria)
- Extremities — causing painful spots in arms and legs
Causes and Risk Factors
Aortic disease, including plaque buildup (atherosclerosis) in the aorta can lead to shaggy aorta syndrome. Many patients with the condition have also had previous surgery to correct aortic disease prior to developing shaggy aorta syndrome.
Atherosclerosis can begin in early adulthood but symptoms may not be evident until many years later as the patient moves into middle and older age. The risk of developing atherosclerosis, and consequently shaggy aorta syndrome, is increased by:
- High blood pressure
- High cholesterol
- Heart disease
- A family history of atherosclerosis
- Moyamoya disease
- Arterial dissection
- Fibromuscular dysplasia
- Takayasu's arteritis
Patients who have a family history of atherosclerosis can lower their risk of stroke through lifestyle changes such as:
- Engaging in regular physical activity
- Lowering their high blood pressure
- Quitting smoking
Diagnosis of shaggy aorta syndrome usually begins with a physical exam and a review of the patient's medical history and symptoms.
After the physical exam, the physician may order tests to examine the heart muscle, the blood flow through the aorta, and any potential blockages. These diagnostic tests may include cardiac MRI, CT scan and CT angiography. With these tests, the aorta may display the characteristic "shaggy" look that distinguishes this condition; however, this is not always the case. For some patients, a transesophageal echocardiography — a type of echocardiography that uses an ultrasound probe inserted through the esophagus —may be used to verify the damage to, or calcification of, the aorta.
Other diagnostic procedures such as blood tests may also be ordered to rule out other possible conditions.
Treatment for shaggy aorta syndrome will generally focus on surgical methods of addressing the condition. The type of surgery performed will depend on the extent of the damage, the risk of recurrent emboli, and the patient's overall health.
For some patients, using a graft or stent graft to replace or cover the damaged area of the aorta may be the best option. The graft is a tube generally made out of synthetic material and may be placed using endovascular surgery, which uses a catheter guided through the vein to place the tube at the damaged area.
The other main surgical treatment option is a bypass. This method allows the surgical team to reroute the blood vein so that it no longer flows through the damaged section.
If shaggy aorta syndrome is associated with another condition, such as atherosclerosis, treatment may also focus on the underlying condition. The knowledgeable and highly trained staff at the Cedars-Sinai Heart Institute will work with each patient to determine the best treatment option.