Objective: This multicenter study compares outcomes of open thoracoabdominal aortic aneurysm (TAAA) repair in patients < 60 years with (n = 106), versus without (n = 167), hereditary aortopathy. Methods: We conducted a retrospective analysis of 273 consecutive open TAAA repairs (2000-2024) at two European centers. The primary endpoint was early outcome. We used a Kaplan-Meier curve to assess survival, and logistic regression to identify predictors. Results: Operative death rates were similar (hereditary: 13/106 [12.3%] vs. non-hereditary: 22/167 [13.2%], p = 0.83). Hereditary aortopathy patients were younger (median 42 vs. 54 years, p < 0.001) with lower BMI (24.1 vs. 28.4 kg/m2, p < 0.001). Non-genetic patients had higher rates of chronic kidney insufficiency (58/167 (34.7%) vs. 14/106 (13.2%), p < 0.001), coronary artery disease (43/167 (25.7%) vs. 9/106 (8.5%), p < 0.001), and prior myocardial infarction (31/167 (18.6%) vs. 4/106 (3.8%), p < 0.001). Hereditary aortopathy patients suffered more often from post-dissection TAAA (68/106 [64.2%] vs. 44/167 [26.3%], p < 0.001) and prior aortic surgery (81/106 (76.4%) vs. 79/167 (47.3%), p < 0.001). Pulmonary complications (67.0% vs. 61.1%, p = 0.32), acute kidney injury (25.5% vs. 22.8%, p = 0.61), and spinal cord ischemia (6.6% vs. 10.2%, p = 0.31) were comparable between groups. Overall 5-year survival was 65.7%; the rate of any reintervention during follow up was 21.2%. Logistic regression identified no predictors for perioperative mortality. Conclusions: Open TAAA repair in patients < 60 years carries relevant perioperative mortality, which is comparable between hereditary and non-hereditary groups; non-hereditary patients had impaired preoperative cardiopulmonary status.

Thoracoabdominal aortic aneurysms (TAAAs) are rare but serious conditions characterized by dilation of the aorta characterized by remodeling of the vessel wall, with changes in the elastin and collagen content. Individuals with Marfan syndrome have a genetic predisposition for elastic fiber fragmentation and elastin degradation and are prone to early aneurysm formation and progression. Our objective was to analyze the medial collagen characteristics through histological, polarized light microscopy, and electron microscopy methods across the thoracic and abdominal aorta in twenty-five patients undergoing open surgical repair, including nine with Marfan syndrome. While age at surgery differed significantly between the groups, maximum aortic diameter and aneurysm extent did not. Collagen content increased from thoracic to infrarenal segments in both cohorts, with non-Marfan patients exhibiting higher collagen percentages, notably in the infrarenal aorta (729.3 nm vs. 1068.3 nm, p = 0.02). Both groups predominantly displayed mature collagen fibers, with the suprarenal segment containing the highest proportion of less mature fibers. Electron microscopy revealed comparable collagen fibril diameters across segments irrespective of Marfan status. Our findings underscore non-uniform histological patterns in TAAAs and suggest that ECM remodeling involves mature collagen deposition, albeit with lower collagen content observed in the infrarenal aorta of Marfan patients.

Background: Open thoracoabdominal aortic aneurysm (TAAA) repair for Crawford extent II aneurysms carries substantial risks. This study compares outcomes of open TAAA repair following prior thoracic endovascular aortic repair (TEVAR) with conventional open extent II repair. Patients and methods: A retrospective analysis of 91 patients (2006-2024) divided into prior TEVAR (n=29) and conventional repair Crawford extent II repair without previous TEVAR (n=62). Primary endpoints included mortality and complications; secondary endpoints assessed survival and reinterventions. This study was designed according to STROBE criteria. Results: The prior TEVAR group (n=29) had a mean age of 61.5±10.7 years and 72.4% were male, while the conventional extent II repair group (n=62) had a mean age of 63.2±9.8 years and 69.4% were male. Prior TEVAR patients underwent open repair for extent II (13.8%), III (58.6%), or IV (27.6%) aneurysms. In-hospital mortality was lower in the prior TEVAR group (6.9% vs. 25.8%, p =.07), as were rates of spinal cord ischemia (3.4% vs. 8.1%, p =.55), acute kidney injury (24.1% vs. 35.5%, p =.28), and massive transfusion (24.1% vs. 30.6%, p =.54). Pulmonary complications occurred less frequently after TEVAR (69.0% vs. 82.3%, p =.25). Kaplan-Meier analysis revealed no significant survival difference (log-rank p=.05), with 5-year survival rates of 94% (prior TEVAR) and 61% (conventional). Aortic reintervention rates were also similar (10.5% vs. 18.8%, p=.69). Conclusions: Open TAAA repair following prior TEVAR may offer clinically meaningful advantages over conventional open type II repair with acceptable survival rates; however, these findings should be interpreted cautiously given the study's retrospective design and small sample size. Staged hybrid approach could be a viable strategy for managing complex aortic pathologies.

Background/Objectives: Open thoracoabdominal aortic aneurysm (TAAA) repair remains essential despite expanded endovascular options, yet the contemporary open-surgery case-mix has shifted as minimally invasive therapies became widespread. The objective was to evaluate temporal changes in patient demographics, pathology, and perioperative outcomes of open TAAA repair across two decades. Methods: Retrospective, cross border cohort of all open TAAA repairs performed at two high-volume tertiary centers (Aachen, Germany; Maastricht, Netherlands) from 2000-2024. Patients were stratified into Early Era (2004-2013) and Late Era (2014-2024). Primary endpoints were shifts in demographics and perioperative mortality/morbidity; secondary endpoints included major complications (spinal cord ischemia, acute kidney injury, pulmonary and cardiac events). Results: Among 577 open repairs, 376 (65.2%) occurred in the Early Era and 201 (34.8%) in the Late Era, with annual volumes declining to <12 cases/year after 2020. Late Era patients were younger (median 55.9 vs. 63.0 years, p<0.001) and had more genetic aortopathy (Marfan 26.9% vs. 11.7%, p<0.01) and post-dissection pathology (64.7% vs. 43.1%, p<0.01), alongside more prior aortic surgery (59.2% vs. 43.4%, p<0.01). Massive transfusion and incidental splenectomy decreased (37.8% vs. 54.5%, p<0.01; 5.0% vs. 14.9%, p<0.01). In-hospital mortality was similar (18.4% Late vs. 21.8% Early, p=0.34); spinal cord ischemia showed a non-significant reduction (5.5% vs. 8.0%, p=0.26); myocardial infarction decreased (1.0% vs. 4.3%, p=0.03); and ARDS increased (15.9% vs. 5.1%, p<0.01). Conclusions: Despite the shift towards endovascular repair and the changing demographics of patients selected for open TAAA repair, specialized centers can maintain stable outcomes through standardized protocols and concentrated expertise. The preservation of open surgical capabilities remains crucial for specific patient populations, emphasizing the need for a balanced approach that integrates both open and endovascular techniques to provide optimal, individualized care.

OBJECTIVE:This study aimed to investigate the correlation between thoraco-abdominal aortic aneurysms (TAAAs) and pre-existing cardiovascular diseases in patients undergoing open aortic surgery and to ascertain the information derived from pre-operative cardiopulmonary workup. METHODS:A retrospective, single centre, cross sectional study was conducted on patients who underwent open TAAA repair between 2006 and 2023. Pre-operative cardiopulmonary workup was evaluated to assess the prevalence of comorbidities. The primary outcome was relevant coronary stenosis requiring pre-operative treatment, and the secondary outcome was any other comorbidities identified during cardiac and pulmonary diagnostics. RESULTS:In this study, 304 patients had a complete or partial cardiopulmonary workup, 261 patients were presented with a cardiac workup, and 231 with a pulmonary workup. The mean patient age was 55.3 ± 12.5 years and 30.3% of the patients were women. In this study, 39.9% of patients had pre-existing lung diseases, 21.4% had connective tissue disease, and nearly half had undergone previous aortic surgery. Congestive heart failure was present in 36.5% of patients. Pulmonary function tests identified obstructive patterns in 19.9% and restrictive patterns in 12.3% of patients. During cardiac workup, 15.7% of patients presented cardiac wall motion abnormalities and 17.2% presented stress induced ischaemia. In patients having cardiac catheterisation, significant stenosis requiring pre-operative stenting was present in 30.5%. CONCLUSION:This study showed the high prevalence of cardiopulmonary diseases in patients with TAAA who are deemed fit for open aortic surgery. It underscores the importance of comprehensive pre-operative cardiopulmonary screening in patients with TAAA and highlights the predictive value of a detailed medical history in identifying patients at risk of coronary stenosis.

Abstract Cytokine-mediated systemic inflammation after open thoracoabdominal aortic aneurysm (TAAA) repairs plays a pivotal role in disrupting circulatory homeostasis, potentially leading to organ dysfunction. The bioactive form of adrenomedullin (bio-ADM) is a peptide hormone with immunomodulatory and vasomotor effects, making it a potential diagnostic agent in these cases. This retrospective, bicentric study, conducted between January 2019 and December 2022, recruited 36 elective open TAAA repair patients in two German centres. Serum and plasma samples were collected at multiple time points to measure bio-ADM levels. The primary objective was to evaluate the association of bio-ADM levels with the onset of acute respiratory distress syndrome (ARDS), with secondary endpoints focusing on mortality and SIRS-related morbidity. Results showed a significant association between postoperative bio-ADM levels (12–48 h after surgery) and the onset of ARDS (p < .001), prolonged ventilation (p = .015 at 12h after surgery), atrial fibrillation (p < .001), and mortality (p = .05 at 24h). The biomarker was also strongly associated with sepsis (p = .01 at 12 h) and multi-organ dysfunction syndrome (MODS) (p = .02 at 24 h after surgery). The study underscores the potential utility of bio-ADM as a diagnostic tool for identifying patients at risk of postoperative complications following open TAAA repairs.

Background: Acute kidney injury (AKI) after open thoracoabdominal aortic aneurysm repairs (TAAA) is a common postoperative complication, associated with increased mortality and morbidity. Early detection and management of the kidney tissue damage remains of paramount importance. The aim of this prospectively conducted, observational trial was to evaluate the clinical applicability of Proenkephalin A 119-159 (penKid) for the detection of postoperative AKI. Patients and methods: Thirty-six patients, planned for elective open TAAA repairs from January 2019 to December 2022, were recruited in two German centres (University Hospital Aachen and Charité - University Hospital Berlin). Blood samples were collected pre-surgery (baseline), directly postoperatively and at 12, 24 and 48 hours after surgery. The penKid concentration in plasma was measured using the immunoluminometric sphingotest® assay kit and they were statistically tested for association with AKI and other clinical parameters. Results: Twenty-four patients (62%) developed moderate or severe AKI postoperatively (Stage 2 or 3 of the KDIGO classification) and they had a significantly increased risk for the development of acute respiratory distress syndrome (p=.023) or a fatal outcome (p=.035). Starting from the 12th hour after surgery, we found penKid correlating with AKI stage 2/3 (12 hour penKid mean in pmol/L: 93.9 vs. 43.1; c index .776, p=.0037) and renal replacement therapy (12 hour c index .779, p=.0035). Patients with multi-organ dysfunction syndrome had significantly increased penKid levels at all timepoints. Conclusions: We found penKid to be a promising biomarker for the early detection of postoperative AKI and in-hospital mortality after open TAAA repair, which may enable the early initiation of organ-protective strategies and reduction of further complications associated with AKI.

Open thoracoabdominal aortic aneurysm (TAAA) repair, despite the rise of endovascular approaches, remains a necessary intervention for complex aortic pathologies, particularly in patients with genetically triggered aortopathies or unsuitable anatomy for endovascular grafts. This paper describes the surgical techniques and perioperative management protocols. We discuss the importance of patient selection, and intraoperative techniques in open TAAA repair. Our protocol routinely consists of neuromonitoring with motor evoked potentials (MEPs) to detect and address spinal cord ischemia in real-time. The "take-home" lesson from our paper is that, while endovascular techniques continue to advance and offer less invasive options for TAAA management, open TAAA repair remains a necessary procedure for certain patients. The expertise in open TAAA repair must be maintained and developed in specialized centers to ensure that all patients have access to the most appropriate and effective treatment.

Background: Percutaneous deep vein arterialization (pDVA) is considered a treatment modality in patients with no-option critical limb ischemia. However, there is still a paucity of evidence regarding its safety and efficacy. Data sources: MEDLINE (via PubMed), Embase and Web of Science databases as well as the CENTRAL registry up to the end of June 2023. Methods: This review adhered to the PRISMA guidelines (PROSPERO registration no. CRD42023445171). The risk of bias was assessed using the methodological index for non-randomized studies (MINORS). Primary endpoints included technical success, overall survival and limb salvage during the follow-up. Amputation-free survival at 30 days, 6 months and 1 year as well as complete wound healing, major adverse limb events and reintervention were investigated as secondary outcomes. Results: Five observational studies, comprising 208 patients (142 Rutherford class 5/77 Rutherford class 6), were included. MINORS revealed a low risk of bias. The meta-analysis reached a pooled technical success rate of 96.2% (95% CI: 91.5–98.4), an overall survival of 82.8% (95% CI: 70.5–95.2) and a limb salvage rate of 77.2% (95% CI: 65.2–89.1) during the follow-up. The amputation-free survival at 30 days, 6 months and 1 year was 87.8%, 68.7% and 65.6%, respectively. Furthermore, pDVA resulted in a complete wound healing rate of 53.4% (95% CI: 30.3–76.5). The pooled reintervention rate was as high as 46.7% (37.1–56.3%). Conclusions: PDVA seems a feasible bail-out strategy for patients with no option for routine treatment of CLTI. However, due to the small number of studies, the strength of the evidence is low.

The training of academic personnel goes beyond the Continuing Medical Education Regulation (WBO). Research and teaching require additional competences and extended curricular contents. After attaining a doctor title, the target of training includes a medical thesis and specialist examination and acquisition of an academic title (PhD) or the habilitation. The additional competences necessary for this academic career must be appropriately incorporated into and mediated during the 6 years of specialized training and beyond. Many modules can be established and mediated in a standardized manner and are therefore valid independent of the location. Appropriate documentation and testing of the curricular implementation are accomplished by means of a logbook. This article presents the proposal of a cross-site jointly structured academic curriculum for physicians being trained as specialists in vascular surgery at university and academic teaching hospitals in Germany.

BACKGROUND:The main aim of this article is to investigate the causes of technical failure during endovascular recanalization in patients with post-thrombotic syndrome with occluded iliofemoral veins and to suggest alternative techniques to improve outcomes in such challenging cases.METHODS:Between November 2015 and August 2020, 230 patients (274 limbs) treated in our institution with symptomatic chronic iliofemoral venous obstruction underwent endovascular recanalization with angioplasty and stent placement. Overall, the initial attempt was unsuccessful in 15 limbs. We retrospectively analyzed the basic demographic and health characteristics of the involved patients and evaluated the endovascular procedures and techniques that resulted in a successful second intervention.RESULTS:The first attempts at endovascular intervention were unsuccessful in 15 of the 274 limbs (5.4%). Failures were attributed to hostile groin areas in intravenous drug abusers caused by multiple punctures in six cases. In addition, five interventions failed due to prior surgery at the site of venous occlusion and in retroperitoneal space, three patients due to severe stent deformity, and one patient due to congenital venous aplasia. Of the 15 patients, 11 underwent a subsequent attempt that included six successful recanalizations. The mean follow-up time of the six patients with successful recanalization was 27 months (5-62 months). The primary, assisted primary and secondary patency rates were 83.3%, 100%, and 100%, respectively. The remaining five patients, in whom the second recanalization attempt failed, received conservative treatment.CONCLUSIONS:Recanalization failure is rare in chronic venous obstruction patients. Severe stent deformities have the lowest chance of successful second intervention. Patients with a hostile groin or prior open surgeries at the occlusion site may be considered for reintervention with a success rate of nearly 50%.

OBJECTIVE:This study aimed to investigate whether prophylactic use of cerebrospinal fluid (CSF) drainage in endovascular descending thoracic aortic aneurysm (DTAA) and thoraco-abdominal aortic aneurysm (TAAA) repair contributes to a lower rate of post-operative spinal cord ischaemia (SCI). DATA SOURCES:MEDLINE, Embase, and CINAHL. REVIEW METHODS:A literature review was conducted in accordance with PRISMA guidelines (PROSPERO registration no. CRD42021245893). Risk of bias was assessed through the Newcastle-Ottawa scale (NOS), and the certainty of evidence was graded using the GRADE approach. A proportion meta-analysis was conducted to calculate the pooled rate and 95% confidence interval (CI) of both early and late onset SCI. Pooled outcome estimates were calculated using the odds ratio (OR) and associated 95% CI. The primary outcome was SCI, both early and lateonset. Secondary outcomes were complications of CSF drainage, length of hospital stay, and peri-operative (30 day or in hospital) mortality rates. RESULTS:Twenty-eight observational, retrospective studies were included, reporting 4 814 patients (2 599 patients with and 2 215 without CSF drainage). The NOS showed a moderate risk of bias. The incidence of SCI was similar in patients with CSF drainage (0.05, 95% CI 0.03 ‒ 0.08) and without CSF drainage (0.05, 95% CI 0.00 ‒ 0.14). No significant decrease in SCI was found when using CSF drainage (OR 0.67, 95% CI 0.29 ‒ 1.55, p = .35). The incidence rate of CSF drainage related complication was 0.10 (95% CI 0.04 ‒ 0.19). The 30 day and in hospital mortality rate with CSF drainage was 0.08 (95% CI 0.05 ‒ 0.12). The 30 day and in hospital mortality rate without CSF drainage and comparison with late mortality and length of hospital stay could not be determined due to lack of data. The quality of evidence was considered very low. CONCLUSION:Pre-operative CSF drainage placement was not related to a favourable outcome regarding SCI rate in endovascular TAAA and DTAA repair. Due to the low quality of evidence, no clear recommendation on pre-operative use of CSF drainage placement can be made.

Gefäßchirurgische Eingriffe werden routinemäßig an unterschiedlichsten Organsystemen durchgeführt, was die spezifischen postoperativen Anforderungen hinsichtlich der Überwachung und Betreuung auf intensivmedizinischen Stationen erklärt. Die gestörte Endothelfunktion als ein Aspekt der Atherosklerose oder von Aneurysmen spielt bei der intra- und postoperativen systemischen Reaktion eine entscheidende Rolle. Postoperative Komplikationen sind vielfältig und nicht selten, sie können sich u. a. als kardiale, zerebrale oder mesenteriale Ischämien manifestieren. Auch systemische Reaktionen, besonders bei chirurgischen Großeingriffen, sind nicht selten und stellen eine diagnostische und therapeutische Herausforderung dar. Durch dieses Kapitel soll dem Leser aus der Sicht von vier Gefäßchirurgen nahegebracht werden, welche Aspekte von Relevanz sein können.

Die Ausbildung akademisch tätiger Mitarbeiterinnen und Mitarbeiter geht über die Weiterbildungsordnung (WBO) hinaus. Forschung und Lehre erfordern zusätzliche Kompetenzen und weiterführende curriculare Inhalte. Das Ausbildungsziel schließt nach der Promotion neben der Facharztprüfung die Erlangung eines akademischen Titels (PhD) oder die Habilitation mit ein. Die für diese akademische Karriere erforderlichen zusätzlichen Kompetenzen müssen in den 6 Weiterbildungsjahren und darüber hinaus entsprechend eingebaut und vermittelt werden. Zahlreiche Module können standardisiert und damit standortübergreifend etabliert und vermittelt werden. Ein Logbuch ermöglicht die entsprechende Dokumentation und Prüfung der curricularen Umsetzung. Im vorliegenden Artikel wird der Vorschlag eines standortübergreifenden, gemeinsamen strukturierten akademischen Curriculums für Ärztinnen und Ärzte in der Weiterbildung zum Facharzt für Gefäßchirurgie an deutschen Universitäten und akademischen Lehrkrankenhäusern vorgestellt.

Die spinale Ischämie im Rahmen von thorakoabdominellen Aortenersatzeingriffen ist mit postoperativen Paresen und Paraplegien vergesellschaftet. Obwohl konventionelle Maßnahmen zum Schutz der perioperativen Rückenmarkperfusion getroffen werden, bleibt das Risiko für neurologische Komplikationen sowohl nach offenen als auch nach endovaskulären Aorteneingriffen relevant. Das neurophysiologische Monitoring von motorisch evozierten Potenzialen erlaubt auf nichtinvasive Art die Früherkennung von Störungen der Rückenmarkintegrität und kann somit intraoperative Strategien zum Schutz des Rückenmarks ermöglichen. Für die Rückenmarkversorgung relevante Interkostalarterien können mithilfe des Neuromonitorings identifiziert und in der aortalen Rekonstruktion in Form von Bypässen integriert werden. Auch in der endovaskulären Aortenchirurgie kann eine Gefährdung der Rückenmarkperfusion frühzeitig erkannt werden. Allerdings, aufgrund adaptierter endovaskulärer Versorgungsstrategien, erfährt das Neuromonitoring klinisch und wissenschaftlich nicht die gleiche Akzeptanz wie in der offenen Aortenchirurgie.

AIMS:Smokers are at increased risk of cardiovascular events. However, the exact mechanisms through which smoking influences cardiovascular disease resulting in accelerated atherosclerosis and vascular calcification are unknown. The aim of this study was to investigate effects of nicotine on initiation of vascular smooth muscle cell (VSMC) calcification and to elucidate underlying mechanisms. METHODS AND RESULTS:We assessed vascular calcification of 62 carotid lesions of both smoking and non-smoking patients using ex vivo micro-computed tomography (µCT) scanning. Calcification was present more often in carotid plaques of smokers (n = 22 of 30, 73.3%) compared to non-smokers (n = 11 of 32, 34.3%; P < 0.001), confirming higher atherosclerotic burden. The difference was particularly profound for microcalcifications, which was 17-fold higher in smokers compared to non-smokers. In vitro, nicotine-induced human primary VSMC calcification, and increased osteogenic gene expression (Runx2, Osx, BSP, and OPN) and extracellular vesicle (EV) secretion. The pro-calcifying effects of nicotine were mediated by Ca2+-dependent Nox5. SiRNA knock-down of Nox5 inhibited nicotine-induced EV release and calcification. Moreover, pre-treatment of hVSMCs with vitamin K2 ameliorated nicotine-induced intracellular oxidative stress, EV secretion, and calcification. Using nicotinic acetylcholine receptor (nAChR) blockers α-bungarotoxin and hexamethonium bromide, we found that the effects of nicotine on intracellular Ca2+ and oxidative stress were mediated by α7 and α3 nAChR. Finally, we showed that Nox5 expression was higher in carotid arteries of smokers and correlated with calcification levels in these vessels. CONCLUSION:In this study, we provide evidence that nicotine induces Nox5-mediated pro-calcific processes as novel mechanism of increased atherosclerotic calcification. We identified that activation of α7 and α3 nAChR by nicotine increases intracellular Ca2+ and initiates calcification of hVSMCs through increased Nox5 activity, leading to oxidative stress-mediated EV release. Identifying the role of Nox5-induced oxidative stress opens novel avenues for diagnosis and treatment of smoking-induced cardiovascular disease.

Spinal ischemia during thoracoabdominal aortic interventions is associated with postoperative paresis and paraplegia. Although conventional measures for protection of perioperative spinal cord perfusion are initiated, there is still a relevant risk of neurological complications with both open and endovascular aortic interventions. Neurophysiological monitoring of motor-evoked potentials enables the early recognition of disorders of spinal cord integrity in a noninvasive manner and can therefore make intraoperative strategies for protection of the spinal cord possible. Intercostal arteries relevant for perfusion of the spinal cord can be identified by neuromonitoring and can be integrated into the aortic reconstruction in the form of bypasses. A threat to spinal cord perfusion can also be recognized at an early stage in endovascular aortic surgery; however, due to adapted endovascular treatment strategies, neuromonitoring has not been clinically and scientifically accepted, as is the case with open aortic surgery.

Neben hämodynamischen Veränderungen im Lumen der dissezierten Aorta, spielen Veränderungen der Wandintegrität eine entscheidende Rolle bei der Entstehung des thorakoabdominellen Postdissektionsaneurysmas. Evaluation der manifesten Degeneration der Media und der elastischen Fasern bei Postdissektionsaneurysmen. Histopathologische Begutachtung des Aortenwandgewebes von Patienten und Primaten mithilfe von HE- und Movat-Färbungen. Statistische Auswertung der Degenerationsmerkmale und Diskussion der aktuellen Literatur. Diffuse Mediadegenerationen und Fibrosen werden ubiquitär in der aneurysmatischen Aorta gefunden. Signifikante Unterschiede lassen sich in allen aortalen Segmenten zwischen Patienten- und Primatenproben nachweisen, jedoch wird der größte Unterschied in den abdominellen Bereichen beobachtet. Von der Degeneration der elastischen Fasern ist die abdominelle Aorta am stärksten betroffen. In der Gruppe der Primaten wurden die höchsten Werte in den thorakalen Bereichen detektiert. Postdissektionsaneurysmen zeigen sich histopathologisch mit einer End-stage-Mediadegeneration und Vernarbung der aortalen Wand. Die kompromittierte Wandintegrität weist auf eine zelluläre Umwandlung der Gefäßwandschicht hin, die neben der veränderten Hämodynamik der Dissektion, die Wachstumsprogredienz der Aneurysmen begünstigen könnte. Zukünftige Untersuchungen der zugrunde liegenden zellulären Prozesse und ihre eventuelle Korrelation mit zirkulierenden Biomarkern könnten zu neuen Screening-Methoden führen.