ETIOLOGY, PATHOGENESIS AND PATHOPHYSIOLOGY OF AORTIC ANEURYSMS AND ANEURYSM RUPTURE Edited by Reinhart T. Grundmann Etiology, Pathogenesis and Pathophysiology of Aortic Aneurysms and Aneurysm Rupture Edited by Reinhart T. Grundmann Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Mirna Cvijic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright Jason Adamson, 2011. First published July, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Etiology, Pathogenesis and Pathophysiology of Aortic Aneurysms and Aneurysm Rupture, Edited by Reinhart T. Grundmann p. cm. ISBN 978-953-307-523-5 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Chapter 1 Etiology and Pathogenesis of Aortic Aneurysms 1 Carl W. Kotze and Islam G. Ahmed Chapter 2 Matrix Metalloproteinases in Aortic Aneurysm – Executors or Executioners? 25 Tomasz Grzela, Barbara Bikowska and Małgorzata Litwiniuk Chapter 3 Mast Cell Density and Distribution in Human Abdominal Aortic Aneurysm 55 Sumiharu Sakamoto, Toshihiro Tsuruda, Kinta Hatakeyama, Yoko Sekita, Johji Kato, Takuroh Imamura, Yujiro Asada and Kazuo Kitamura Chapter 4 The Role of Complement in the Pathogenesis of Artery Aneurysms 67 Fengming Liu, Annie Qin, Lining Zhang and Xuebin Qin Chapter 5 Immunoglobulin G4-Related Inflammatory Aortic Aneurysm 91 Mitsuaki Ishida and Hidetoshi Okabe Chapter 6 Transcriptomic and Proteomic Profiles of Vascular Cells Involved in Human Abdominal Aortic Aneurysm 105 Florence Pinet, Nicolas Lamblin, Philippe Ratajczak, David Hot, Emilie Dubois, Maggy Chwastyniak, Olivia Beseme, Hervé Drobecq, Yves Lemoine, Mohammad Koussa and Philippe Amouyel Chapter 7 Multifaceted Role of Angiotensin II in Vascular Inflammation and Aortic Aneurysmal Disease 119 Xiaoxi Ju, Ronald G. Tilton and Allan R. Brasier Chapter 8 Aortitis and Aortic Aneurysm in Systemic Vasculitis 137 Ana García-Martínez, Sergio Prieto-González, Pedro Arguis, Georgina Espígol, José Hernández-Rodríguez and Maria C Cid VI Contents Chapter 9 Drug-Induced Aortic Aneurysms, Ruptures and Dissections 159 Olav Spigset Chapter 10 Pathophysiology of Abdominal Aortic Aneurysm Rupture and Expansion: New Insight on an Old Problem 175 Efstratios Georgakarakos and Christos V. Ioannou Chapter 11 An Analysis of Blood Flow Dynamics in AAA 191 Bernad I. Sandor, Bernad S. Elena, Barbat Tiberiu, Brisan Cosmin and Albulescu Vlad Chapter 12 Numerical Simulation in Aortic Arch Aneurysm 207 Feng Gao, Aike Qiao and Teruo Matsuzawa Preface This book considers mainly etiology, pathogenesis, and pathophysiology of aortic aneurysms (AA) and aneurysm rupture and addresses anyone engaged in treatment and prevention of AA. Multiple factors are implicated in AA pathogenesis, and are outlined here in detail by a team of specialist researchers. Initial pathological events in AA involve recruitment and infiltration of leukocytes into the aortic adventitia and media, which are associated with the production of inflammatory cytokines, chemokine, and reactive oxygen species. AA development is characterized by elastin fragmentation. As the aorta dilates due to loss of elastin and attenuation of the media, the arterial wall thickens as a result of remodeling. Collagen synthesis increases during the early stages of aneurysm formation, suggesting a repair process, but resulting in a less distensible vessel. Proteases identified in excess in AA and other aortic diseases include matrix metalloproteinases (MMPs), cathepsins, chymase and others. The elucidation of these issues will identify new targets for prophylactic and therapeutic intervention. Prof. Dr. Reinhart T. Grundmann Medical Expert Burghausen Germany [...]... pp.659-73, ISSN 0022-5223 Dawson, J.; Choke, E.; Loftus, I.; Cockerill, G.; Thompson, M (2011) A randomised placebocontrolled double-blind trial to evaluate lipid-lowering pharmacotherapy on 18 Etiology, Pathogenesis and Pathophysiology of Aortic Aneurysms and Aneurysm Rupture proteolysis and inflammation in abdominal aortic aneurysms European Journal of Vascular and Endovascular Surgery, Vol.41, No.1, (January... is associated with extensive destruction of 26 Etiology, Pathogenesis and Pathophysiology of Aortic Aneurysms and Aneurysm Rupture elastic fibers in the tunica media layer, and infiltration of both, media and adventitia, by macrophages and lymphocytes, mainly the Th2 subset Moreover, as has been found recently, outer media and adventitia of human aortic aneurysm samples contain numerous mast cells (Miyake... al, 2010) The role of ILT in AA pathogenesis merits further discussion and will be explored in subsequent chapters 2 Etiology, Pathogenesis and Pathophysiology of Aortic Aneurysms and Aneurysm Rupture Uncertainty exists as to the impact of reported AA risk factors since the incidence of AAA is increasing despite a general reduction in tobacco use and an ever-increasing incidence of diabetes, which... Pathobiology of Idiopathic Ascending Aortic Aneurysms Asian Cardiovascular Thoracic Annals, vol.14 no.3, (June 2006), pp 254-260 20 Etiology, Pathogenesis and Pathophysiology of Aortic Aneurysms and Aneurysm Rupture Koeppel, T.; Gahlen, J.; Diehl, S.; Prosst, R.; Dueber, C (2004) Mycotic aneurysm of the abdominal aorta with retroperitoneal abscess: successful endovascular repair Journal of Vascular... (2001) Pathogenesis of abdominal aortic aneurysms: A multidisciplinary research program supported by the National Heart, Lung, and 24 Etiology, Pathogenesis and Pathophysiology of Aortic Aneurysms and Aneurysm Rupture Blood Institute Journal of Vascular Surgery, Vol.34, No 4, (October 2001), pp 730-8 doi:10.1067/mva.2001.116966 Werb, Z.; Bainton, D.; Jones, P (1980) Degradation of connective tissue... leading to reduction of MMP-9 and PGE2 (Miralles et al, 1999) More recently, the antioxidant properties of Vitamin E have been investigated in AAA 16 Etiology, Pathogenesis and Pathophysiology of Aortic Aneurysms and Aneurysm Rupture models It has been shown to block the induction of AAA in Angiotensin II-infused Apo-E knockout mice via reduction of macrophage infiltration and reduction of a chemotactic... ABCC6 Table 2 Genetic diseases and Aortic Aneurysms 3.3 General behaviour of familial aneurysms 3.3.1 Aneurysm expansion TAA is a lethal disease and the size of the aneurysm has a profound impact on aortic dissection and death (Coady et al, 1999) The growth rate of TAA is highly variable ranging from 0.03 to 0.22 cm per year Genetic factors may play an important role in aortic growth rates The data suggests... chemical and mechanical injury is responsible for aneurysm development, rather 12 Etiology, Pathogenesis and Pathophysiology of Aortic Aneurysms and Aneurysm Rupture than direct elastolysis The calcium chloride murine model further indicates that CD4+ lymphocytes may be central in orchestrating production of MMP-2 and MMP-9 through interferon gamma (Xiong et al, 2004; Gertz et al, 1988) Anidjar and Dobrin...1 Etiology and Pathogenesis of Aortic Aneurysms Carl W Kotze and Islam G Ahmed University College London United Kingdom 1 Introduction The introduction of aneurysm screening programmes in North America and Europe has led to a significant increase in the number of new diagnoses The pathobiology of aortic aneurysm (AA) is both complex and multifactorial, and is associated with several... J (2010) The pathophysiology of abdominal aortic aneurysm growth: Corresponding and discordant inflammatory and proteolytic processes in abdominal aortic and popliteal artery aneurysms Journal of Vascular Surgery, Vol.51, No.6, (June 2010), pp 1479-87, ISSN 1097-6809 Ailawadi, G.; Eliason, J.; Upchurch, G (2003) Current concepts in the pathogenesis of abdominal aortic aneurysm Journal of Vascular Surgery, . ETIOLOGY, PATHOGENESIS AND PATHOPHYSIOLOGY OF AORTIC ANEURYSMS AND ANEURYSM RUPTURE Edited by Reinhart T. Grundmann Etiology, Pathogenesis and Pathophysiology. The role of ILT in AA pathogenesis merits further discussion and will be explored in subsequent chapters. Etiology, Pathogenesis and Pathophysiology of Aortic Aneurysms and Aneurysm Rupture. and Aortic Aneurysms 3.3 General behaviour of familial aneurysms 3.3.1 Aneurysm expansion TAA is a lethal disease and the size of the aneurysm has a profound impact on aortic dissection and