Aorta

This volume collects 34 articles on the aorta written by Dr. William C. Roberts and colleagues between 1972 and 2022. It is part of a series of collected reprints published in 2023 gathering publications from Dr. Roberts’ long career.The aorta is the super highway of the vascular system. It is prone to many diseases, the most common being atherosclerosis (an intimal disease), aortic dissection (a medial disease), and syphilis (initially an adventitial disease). Atherosclerosis generally spares the ascending aorta (or coronary bypass would be far less successful) and worsens as the aorta progresses from proximal to distal. The intimal plaques press on the media as they enlarge, resulting most commonly in aneurysms. Aortic dissection tends to involve aortas that contain relatively few atherosclerotic plaques. If hypercholesterolemia is the precursor of atherosclerosis, systemic hypertension is the precursor of aortic dissection. The intimal-medial tear most commonly is in the ascending aorta, with tears in the proximal descending aorta the second most common site. Aortic syphilis has not gone away. It spares the wall of the sinuses of Valsalva and begins at the sinotubular junction, causing dilation of the tubular portion of aorta, involving every square centimeter of its intimal surface. The result is fibrous thickening of the intima, marked loss of elastic fibers in the media, and thickening of the adventitia by dense fibrous tissue containing focal collections of plasmacytes and lymphocytes and thickened vasa vasorum. Of course, there are many other conditions that occasionally involve the aorta, but atherosclerosis, acute dissection, and syphilis are the top three.