Structural Remodeling of the Extracellular Matrix in Arteriogenesis: A Review
Lower extremity arterial occlusive disease (AOD) results in significant morbidity and mortality for the population, with up to 10% of patients ultimately requiring amputation. An alternative method for non-surgical revascularization which is yet to be fully understood is the optimization of the body...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-11-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.761007/full |
| _version_ | 1818934508215336960 |
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| author | Rohan Kulkarni Elizabeth Andraska Ryan McEnaney Ryan McEnaney |
| author_facet | Rohan Kulkarni Elizabeth Andraska Ryan McEnaney Ryan McEnaney |
| author_sort | Rohan Kulkarni |
| collection | DOAJ |
| description | Lower extremity arterial occlusive disease (AOD) results in significant morbidity and mortality for the population, with up to 10% of patients ultimately requiring amputation. An alternative method for non-surgical revascularization which is yet to be fully understood is the optimization of the body's own natural collateral arterial network in a process known as arteriogenesis. Under conditions of conductance vessel stenosis or occlusion resulting in increased flow, shear forces, and pressure gradients within collaterals, positive remodeling occurs to increase the diameter and capacity of these vessels. The creation of a distal arteriovenous fistula (AVF) will drive increased arteriogenesis as compared to collateral formation with the occlusion of a conductance vessel alone by further increasing flow through these arterioles, demonstrating the capacity for arteriogenesis to form larger, more efficient collaterals beyond what is spontaneously achieved after arterial occlusion. Arteries rely on an extracellular matrix (ECM) composed of elastic fibers and collagens that provide stability under hemodynamic stress, and ECM remodeling is necessary to allow for increased diameter and flow conductance in mature arterial structures. When positive remodeling occurs, digestion of lamella and the internal elastic lamina (IEL) by matrix metalloproteinases (MMPs) and other elastases results in the rearrangement and thinning of elastic structures and may be replaced with disordered elastin synthesis without recovery of elastic function. This results in transmission of wall strain to collagen and potential for aneurysmal degeneration along collateral networks, as is seen in the pancreaticoduodenal artery (PDA) after celiac occlusion and inferior mesenteric artery (IMA) with concurrent celiac and superior mesenteric artery (SMA) occlusions. Further understanding into the development of collaterals is required to both better understand aneurysmal degeneration and optimize collateral formation in AOD. |
| first_indexed | 2024-12-20T05:05:23Z |
| format | Article |
| id | doaj.art-af19d21481fd4eacb260525523636a13 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-20T05:05:23Z |
| publishDate | 2021-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-af19d21481fd4eacb260525523636a132022-12-21T19:52:25ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-11-01810.3389/fcvm.2021.761007761007Structural Remodeling of the Extracellular Matrix in Arteriogenesis: A ReviewRohan Kulkarni0Elizabeth Andraska1Ryan McEnaney2Ryan McEnaney3Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United StatesDivision of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United StatesDivision of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United StatesVeterans Affairs Hospitals Pittsburgh Healthcare System, Pittsburgh, PA, United StatesLower extremity arterial occlusive disease (AOD) results in significant morbidity and mortality for the population, with up to 10% of patients ultimately requiring amputation. An alternative method for non-surgical revascularization which is yet to be fully understood is the optimization of the body's own natural collateral arterial network in a process known as arteriogenesis. Under conditions of conductance vessel stenosis or occlusion resulting in increased flow, shear forces, and pressure gradients within collaterals, positive remodeling occurs to increase the diameter and capacity of these vessels. The creation of a distal arteriovenous fistula (AVF) will drive increased arteriogenesis as compared to collateral formation with the occlusion of a conductance vessel alone by further increasing flow through these arterioles, demonstrating the capacity for arteriogenesis to form larger, more efficient collaterals beyond what is spontaneously achieved after arterial occlusion. Arteries rely on an extracellular matrix (ECM) composed of elastic fibers and collagens that provide stability under hemodynamic stress, and ECM remodeling is necessary to allow for increased diameter and flow conductance in mature arterial structures. When positive remodeling occurs, digestion of lamella and the internal elastic lamina (IEL) by matrix metalloproteinases (MMPs) and other elastases results in the rearrangement and thinning of elastic structures and may be replaced with disordered elastin synthesis without recovery of elastic function. This results in transmission of wall strain to collagen and potential for aneurysmal degeneration along collateral networks, as is seen in the pancreaticoduodenal artery (PDA) after celiac occlusion and inferior mesenteric artery (IMA) with concurrent celiac and superior mesenteric artery (SMA) occlusions. Further understanding into the development of collaterals is required to both better understand aneurysmal degeneration and optimize collateral formation in AOD.https://www.frontiersin.org/articles/10.3389/fcvm.2021.761007/fullarteriogenesisextracellular matrixelastic fiberoutward remodelingcollateral arteriesarterial occlusive disease |
| spellingShingle | Rohan Kulkarni Elizabeth Andraska Ryan McEnaney Ryan McEnaney Structural Remodeling of the Extracellular Matrix in Arteriogenesis: A Review Frontiers in Cardiovascular Medicine arteriogenesis extracellular matrix elastic fiber outward remodeling collateral arteries arterial occlusive disease |
| title | Structural Remodeling of the Extracellular Matrix in Arteriogenesis: A Review |
| title_full | Structural Remodeling of the Extracellular Matrix in Arteriogenesis: A Review |
| title_fullStr | Structural Remodeling of the Extracellular Matrix in Arteriogenesis: A Review |
| title_full_unstemmed | Structural Remodeling of the Extracellular Matrix in Arteriogenesis: A Review |
| title_short | Structural Remodeling of the Extracellular Matrix in Arteriogenesis: A Review |
| title_sort | structural remodeling of the extracellular matrix in arteriogenesis a review |
| topic | arteriogenesis extracellular matrix elastic fiber outward remodeling collateral arteries arterial occlusive disease |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2021.761007/full |
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