(A714) Dysphagia Aortica: A Systematic Review

Introduction: Dysphagia aortica is characterized by difficulty swallowing due to extrinsic compression of the esophagus by an aneurysmal, dilated, or tortuous aorta. Despite causing significant morbidity, it remains under-recognized due to its nonspecific presentation and rarity. This systematic review aims to enhance understanding and provide otolaryngologists with insights into diagnosis and treatment.

Methods: A search of PubMed and EMBASE using “Dysphagia Aortica,” “Dysphagia Aortic,” and “Dysphagia Aorta” was conducted. Two reviewers then performed a descriptive analysis to identify patterns in presentation, diagnostics, and treatment.

Results: Of 109 initial papers, 36 met inclusion criteria after excluding non-human, pediatric, and non-English studies, comprising 37 patients with dysphagia aortica. The mean age was 65 yrs (range of 22-98), with a 1:1 male to female ratio. All patients presented with dysphagia. Common coexisting symptoms included shortness of breath and/or chest pain (24%) and unintentional weight loss (22%). Diagnosis was made with computed tomography and barium swallow. Aneurysmal aorta was the most common etiology (68%), followed by a tortuous or right-sided aortic arch. Surgical management such as TEVAR, open aortic repair, and vascular correction was recommended for most patients (62%). Four patients refused surgery or succumbed before the operation. Postoperative mortality was (5%). Conservative treatments, including dietary modifications and blood pressure control, were utilized in (30%) of patients, though (18%) reported persistent symptoms.

Conclusions: Although rare, otolaryngologists should consider dysphagia aortica in older patients presenting with dysphagia. This review discusses the role of swallow evaluation, imaging, and surgical intervention. Current literature is limited, and further studies are needed to refine diagnostics and therapies.