Major gaps in human evidence for structure and function of the vasa vasora limit our understanding of the link with atherosclerosis

Abstract

Atherosclerosis is the major pathology causing death in the developed world and, although risk factor modification has improved outcomes over the last decade, there is no cure. The role of the vasa vasora (VV) in the pathogenesis of atherosclerotic plaque is unclear but must relate to the predictability of diseased sites in the arterial tree. VV are small vessels found on major arteries and veins which supply nutrients and oxygen to the vessel wall itself while removing waste. Numerous studies have been carried out to investigate the anatomy and function of the VV as well as their significance in vascular disease. There is convincing evidence that VV are related to atherosclerotic plaque progression and vessel thrombosis, however, their link to the pathology of plaque initiation remains an interesting but neglected topic. We aim to present the evidence on the anatomy and functional behaviour of VV as well as their relationship to the initiation of atherosclerosis. At the same time, we wish to highlight inconsistencies in, and limitations of, the evidence available.

TLN1 synergizes with ITGA5 to ameliorate cardiac microvascular endothelial cell dysfunction

“…Atherosclerotic plaque builds up in the blood vessels that supply the heart with oxygen and nutrients [20,33]. The complex process of atherosclerosis begins early and is thought to begin with dysfunction of coronary endothelial cells [2].…”

Response of the carotid artery longitudinal motion to submaximal physical activity in healthy humans—Marked changes already at low workload

“…Furthermore, the smooth muscle cells of the media and the extracellular matrix components have proven to be capable of numerous functions considered important in the pathogenesis of vascular diseases such as atherosclerosis (Hunt et al, 2002), and the longitudinal motion and its changes during physical activity has the potential to have impact on this as well. Furthermore, the adventitia, the outermost layer of the arterial wall of larger arteries, contains small blood vessels, the vasa vasorum (“vessels of vessels”), which in the largest arteries also penetrate into the media (for reviews see Ritman & Lerman, 2007; Zhao et al, 2021), that is, passing through the area of the demonstrated changing cyclic shear strain. There is increasing evidence suggesting a role for the vasa vasorum in the development of atherosclerotic vascular disease (for review see Xu J et al 2015), and it is reasonable to hypothesize that changes in longitudinal motion and resulting cyclic shear strain influence the circulation of the vasa vasorum possibly/probably causing transient compression of the vasa vasorum.…”