Recent studies have shown that increases in proteolytic activity are associated with abdominal aortic aneurysms (AAAs). We have studied samples of the dilated aortic wall, taken during corrective surgery for AAAs, in terms of the number, type, and tissue location of connective tissue proteinases and their inhibitors. Five distinct caseinolytic serine proteinases and six gelatinolytic metalloproteinases were resolved by molecular weight by use of sodium dodecyl sulfate-substrate gel electrophoresis. Isoforms of the Mr 92,000 neutrophil gelatinase were identified by immunoprecipitation of biosynthetically labeled organ culture media. About 50% of the total radiolabeled protein secreted by AAA organ cultures was identified as the Mr 30,000 glycoprotein, tissue inhibitor of metalloproteinase (TIMP), by immunoprecipitation. Both TIMP and gelatinase were localized to the vasa vasorum by immunoperoxidase staining. However, interstitial collagenase could not be detected by any method. These results suggest the involvement of the vasa vasorum in the maintenance and possibly the genesis of AAAs.

Connective tissue proteinases and inhibitors in abdominal aortic aneurysms. Involvement of the vasa vasorum in the pathogenesis of aortic aneurysms.

Spontaneous dissecting aneurysm of the aorta in man is most commonly a sequel of hypertension but sometimes occurs in association with degenerative liquefaction of the media of the aorta. New light has been thrown upon dissecting aneurysm by its production in growing rats by a diet high in sweet peas. The offending agent has been isolated and a number of simpler related compounds have been synthesized and found effective. The relationship of this syndrome to a spontaneous dissecting aneurysm of the aorta in man is reviewed and some suggestions are made for investigation which may lead to newer methods of therapy.

Dissecting aneurysm produced by diet.

The clinical diagnosis of dissecting aneurysm of the aorta depends on awareness of the entity, keen clinical suspicion, and an understanding of the varied manifestations. Clinical suspicion is sharpened by association of certain preexisting conditions found to be related to an increased incidence of aortic dissection. Recognition of the Marfan's syndrome, pregnancy, or preexisting hypertension in a patient presenting as an acute catastrophe may lead to the diagnosis. A family history of aortic dissection is similarly helpful. The variable manifestations call for careful reasoning. Multiple system involvement in many cases is the initial lead in establishing the diagnosis. The many systems frequently involved in the symptomatology of aortic dissection have in common the origin of the blood supply. When the aorta is damaged, branches to various organs may be affected so that the symptoms depend on the branches involved. Because any portion of the aorta may be involved in the dissecting process, no single cl...

Dissecting Aneurysm of the Aorta The Clinical Features of Thirty Autopsied Cases

Increasing prevalence of hypertension among patients with thoracic aorta dissection: trends over eight decades--a structured meta-analysis.

Krankheiten der Gefäße

REPEATED attempts have been made to ascertain the underlying etiologic factors in idiopathic cystic necrosis of the aorta since it was first described by Gsell1and by Erdheim.2Workers have pursued several courses, among which have been the morphologic and the experimental. Among the former, the work of Erdheim is still fundamental and outstanding. He noted specifically the absence of vasa vasorum at the site of rupture in those instances in which the aorta showed the typical picture of medial necrosis. In other cases, he observed some degree of hyalinization. Despite his observations and the later work of Wiese,3he stated the belief that the vasa vasorum did not play a role in the production of medionecrosis of the aorta. He favored the idea of some form of hyperadrenalism as the possible etiologic factor. Later workers4noted alterations of the vasa vasorum. Attempts to reproduce the

George D. Amromin

Papers

Dissecting aneurysms of the aorta