Extensive studies into the etiology of aortic aneurysm disease have focused on the characteristic and unique inflammatory infiltration and elaboration of products of inflammatory cells which can result in matrix degradation. While these changes clearly have a significant impact on the development of aneurysm disease, little attention has been paid to the changes in the parenchymal cells of the aorta. Under normal conditions, the vascular smooth muscle cells which populate the aortic wall are responsible for the maintenance of the matrix components of the media, particularly the elastic fibers. As our understanding of the mechanisms of aneurysm formation and normal arterial anatomy become more sophisticated, it is clear that specific changes to these smooth muscle cells make them active participants in the medial matrix destruction characteristic of aneurysm disease. As others have described for intimal arterial disease, this is the “soil” from which aortic aneurysms grow.
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