The implication of vasa vasorum in surgical diseases of the aorta

Abstract

Vasa vasorum (VV) are microscopic vases that perfuse the vessel's wall; arteries and veins. Many recent researches support the opinion that VV have a significant role in aortic pathology. The VV, or 'the vessels of the vessels', form a network of microvessels that lie in the adventitia and penetrate the outer media of the host vessel wall. Although the importance of the VV in providing nutritional support is not well known, obstruction of blood flow through these vessels has been implicated in the pathogenesis of many cardiovascular diseases such as aortic intramural hematoma, aortic aneurysm, and acute or chronic aortic dissection. Although the proliferation of VV due to atherogenic stimuli is controversial, experimental and clinical studies strongly suggest the potential of VV in vascular proliferative disorders. It seems that the rupture of VV is implicated in intramural hematoma, which can develop in acute aortic dissection. In this review article, we would like to stress the anatomy and mainly the pathophysiology, and the implication of VV in the acute and chronic aortic pathologies.

An under Recognized Cause of Chest Pain

“…Though deemed as pathologically distinct entities, intramural hematoma may lead into acute aortic dissection, aneurysm or aortic rupture. 4 …”

“…4 Vaso vasorum vessels of vessels , forms network of vessels in adventitia, which also supply the outer media plays a significant role in pathogenesis of all aortic pathologies including intramural hematoma, aortic dissection and aortic aneurysm. 4 Animal studies have shown that aortic distensibility decreases when vaso vasorum are removed from the vessel wall. Penetrating atherosclerotic ulcer develops, when an atheromatous plaque, ulcerates through the internal elastic lamina and exposes the media to high-pressure aortic blood flow leading to intra medial hematoma.…”

Aneurysms and Dissections

“…19-17). 38,41 The extent of IMH is classified by the Stanford approach as type A and type B. Class II is defined as IMH with hematoma formation within the medial layer.…”

Histologic identification of brown adipose and peripheral nerve involvement in human atherosclerotic vessels

“…These nerves have been shown to be associated with unique microvasculature, termed the vasa vasorum, in the adventitia (for review see [19]). This microvasculature has been implicated in plaque formation and associated with two neuro-inflammatory factors, substance P (SP) and calcitonin gene related peptide (CGRP) [19–21]. …”