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Review
.2007 Sep 1;75(4):649-58.
doi: 10.1016/j.cardiores.2007.06.020. Epub 2007 Jun 29.

The dynamic vasa vasorum

Affiliations
Review

The dynamic vasa vasorum

Erik L Ritman et al. Cardiovasc Res..

Abstract

The function of vasa vasorum is both to deliver nutrients and oxygen to arterial and venous walls and to remove "waste" products, either produced by cells in the wall or introduced by diffusional transport through the endothelium of the artery or vein. Although the relationship between changes in vasa vasorum characteristics and the development of atheromatous plaques is well documented, the role of vasa vasorum, especially in terms of their appearance and disappearance in disease processes such as atherosclerosis, are still not clearly understood in terms of their being causative or merely reactive. However, even if their proliferation is merely reactive, these new microvessels may be a source of disease progression by virtue of endothelial impairment and as a pathway for monocytic cells to migrate to sites of early disease. As both these features are aspects of the vasa vasorum function, this Review focuses on the following issues: 1) acute modulation of vasa vasorum patency due to surrounding compressive forces within vessel wall and due to variable tone in the smooth muscle within proximal vasa vasorum and 2) chronic angiogenic responses due to local cytokine accumulations such as occur in the wall of arteries in the presence of hypertension, hypercholesterolemia, accumulation of lipids, extravasated blood products (e.g., red blood cells, macrophages, inflammatory products) which attract monocytes, and response of vasa vasorum to pharmacological stimuli.

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Figures

Figure 1
Figure 1
Top two panels are micro-CT transaxial images through a porcine coronary artery. The white regions are a radiopaque silicon-based polymer injected into the vascular lumen. In the left panel the polymer was injected into the coronary artery lumen at 100 mmHg pressure and in the right panel it was injected into the concomitant vein’s lumen at 100 mmHg pressure. The arrows point to opacified vasa vasorum around the main lumen. These conditions result in the larger coronary arterial lumen due to the higher intracoronary intralumenal pressure in the left upper panel and the increased number of vasa vasorum due to the reduced arterial lumen pressure resulting in a proportional decrease in the intramural pressure in the right panels. The lower panels are the corresponding axial projections of those arteries after the contrast in the main lumens was “removed” by image manipulation.
Figure 2
Figure 2
Upper left panel: Volume-rendered micro-CT image of a porcine right coronary artery (20 μm cubic voxel size). The origin of the vasa vasorum interna from the main coronary artery lumen is indicated by the arrow. Right panels: grayscale-inverted μ-CT cross-sections with areas of perfusion. These areas of perfusion enclose the vasa vasorum branches that belong to the tree in the upper left panel. After adding the areas of perfusion in all contiguous cross-section images, the volume of vessel wall perfused can be assessed (lower left panel). [With permission from Gössl M et al., Ref. 29].
Figure 3
Figure 3
This is a flow chart of the proposed cascade of events triggered by increased risk factors (such as elevated plasma lipids) and altered endothelial function. There are positive feedback loops (e.g., A, C) which result in progressive plaque formation and ultimately plaque rupture or plaque calcification. The negative feedback loops (e.g., B) involve the salutary effect of new vasa vasorum formation and the anti-angiogenesis association of plaque stabilization with calcification. The relative magnitude and time of onset of these various reactions to the initial stimuli determine the specific course followed (i.e., relentless progression vs. self limiting) in any one individual case. (See text for more detailed discussion).
Figure 4
Figure 4
Micro-CT transaxial images of a double knockout mouse (LDL-/-, apoE-/-) aorta after it was injected with a radiopaque silicon polymer. The aortic lumen (large white area) is irregular rather than round because of the atherosclerotic plaques encroaching into the lumen. The small vessels around the lumen are vasa vasorum. Note that unlike the “clear” zone between the vasa vasorum and the main lumen in the normal artery (upper panels of Fig. 1), the black arrows in this image show vasa vasorum entering the plaque area close to the main lumen surface. These are the newly formed vasa vasorum in response to the plaque formation process. Also, the white arrows point to isolated punctate opacities in the region of the plaques. These were shown to be small accumulations of iron and calcium, presumably the remains of red blood cells. [Abridged version of Figure 3 with permission from Langheinrich AC et al., Ref. 109].
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References

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