The aorta is the major blood vessel with spiral shaped geometry where the flow pattern is swirling in late systole. The swirling blood flow may have a positive physiological role in preventing cardiovascular diseases by reducing turbulent flow and enhancing mass transport. Several factors have shown to contribute to the formation of the swirling flow in the aorta such as the ventricular twisting, the 3D spiral shaped aorta, the pulsatile blood flow in the aorta and the motion of ascending aorta. Inspired by the above basic researches, the swirling flow mechanism has been applied to the vascular interventional therapies and the design of cardiovascular interventional devices. In the present review, the observation of swirling patterns in the aorta, its physiological significance, the factors contributing to its formation and its potential clinical application are summarized.