Vasa Vasorum in Deep Vein Thrombus Recanalization

Abstract

Vasa vasorum is a microvessel known as "the vessel of the vessels." It is found in tunica media in the wall of blood vessels. It is normally not visualized due to its microscopic structure, but when enough extra pressure compresses the wall of a blood vessel, by the presence of an acute thrombus for an example, this microvessel can be visualized. This case study explains how to identify vasa vasorum by analyzing Doppler waveforms. Furthermore, this case study suggests that the appearance of vasa vasorum in the 3-month follow-up may indicate that the overall recanalization of a thrombus may be more complex than how it is suggested in a published case study by Brandao and his colleagues.

Vasa vasorum: The role in intracranial physiology and pathophysiology

“…Induced VVs provide a route for inflammatory cell infiltration and accelerate aneurysm wall inflammation. [31,53] As seen in atherosclerotic lesions, secondary-induced VVs have impaired endothelium integrity, [45,71] increasing permeability and accelerating further inflammatory cell infiltration and causing hemorrhage within or on the surface of the aneurysmal wall. [32,71] rough these mechanisms, VVs are associated with aneurysm wall weakening, growth, and rupture [Figure 4].…”

“…Meanwhile, one study reported that the density of VVs was similar between unruptured and ruptured aneurysms and that VVs with increased permeability were significantly higher in ruptured aneurysms. [45] Accordingly, the "leaky" weakened vessel wall prone to inflammation can be involved in wall enhancement rather than the VV density. VWI is now widely used to identify fragile rupture sites in cerebral aneurysms and other hemorrhagic strokes, including brain arteriovenous malformations [17,48,50] and DAVFs.…”

“…Indeed, some authors reported a case of a growing aneurysm even after angiographical complete occlusion had been achieved. [45,53] Endovascular treatment cannot cure these lesions, and surgical resection is mandatory. Future treatment may not only target the blood flow inside the aneurysm but also target the background mechanism, including VVs involved in the instability of the aneurysmal wall.…”