The aorta is the largest artery in the body, a single high-pressure trunk that receives all the cardiac output and distributes it to every organ system through its branches. Its elastin-rich wall acts as a reservoir, converting the pulsatile cardiac ejection into a steadier flow (Windkessel effect) that protects downstream arterioles. Aortic disease produces some of the most dramatic and lethal cardiovascular emergencies encountered in clinical practice.
| Origin | Left ventricle of the heart |
|---|---|
| Course | Ascends from the heart as the ascending aorta, arches posteriorly as the aortic arch giving off the great vessels, descends through the thorax as the descending thoracic aorta, passes through the aortic hiatus at T12, and becomes the abdominal aorta dividing at L4 into the common iliac arteries |
| Branches |
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Aortic aneurysm (dilatation exceeding 50 percent of normal diameter) most commonly involves the infrarenal abdominal aorta, with a threshold for elective repair of 5.5 cm in men and 5.0 cm in women given the rupture risk. Acute aortic dissection (type A involving the ascending aorta, type B sparing the ascending aorta) produces the worst-ever tearing chest pain radiating to the back and is a surgical emergency for type A. Aortic coarctation at the ductus arteriosus level in children produces upper limb hypertension, rib notching from collateral intercostal artery enlargement, and a 3-sign on chest radiograph.
Intimal tear allowing blood into the aortic wall creating a false lumen, producing severe tearing chest-to-back pain requiring emergency surgery for type A and medical management for uncomplicated type B.
Infrarenal aortic dilatation over 3 cm managed with surveillance by ultrasound until repair threshold (5.5 cm in men) when endovascular or open repair is performed.
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