Vascular mechanics has been studied in depth since the early 1970s mainly
following classical concepts from continuum mechanics. Yet, an important distinction of
blood vessels, in contrast to typical engineering materials, is the continuous degradation
and deposition of material in these living tissues. In this paper we examine mechanical
consequences of such mass turnover. Motivated by Lyapunovâs stability theory, we
introduce the new concepts of mechanobiological equilibrium and stability and demonstrate
that blood vessels can maintain their structure and function under physiological
conditions only if new material is deposited at a certain prestress and the vessels are
both mechanically and mechanobiologically stable. Moreover, we introduce the concept of
mechanobiological adaptivity as a third corner stone to understand vascular behavior on a
continuum level. We demonstrate that adaptivity represents a key difference between the
stability of mechanobiological and typical human-made systems. Based on these ideas, we
suggest a change of paradigm that can be illustrated by considering a common arterial
pathology. We suggest that aneurysms can be interpreted as mechanobiological instabilities
and that predictions of their rupture risk should not only consider the maximal diameter
or wall stress, but also the mechanobiological stability. A mathematical analysis of the
impact of the different model parameters on the so-called mechanobiological stability
margin, a single scalar used to characterize mechanobiological stability, reveals that
this stability increases with the characteristic time constant of mass turnover, material
stiffness, and capacity for stress-dependent changes in mass production. As each of these
parameters may be modified by appropriate drugs, the theory developed in this paper may
guide both prognosis and the development of new therapies for arterial pathologies such as
aneurysms.