Mechanisms underlying arterial fragility and the complications of atherosclerosis.

The etiology of atherosclerosis must explain the development of primary pathological complications (intimal tears, ectasia, tortuosity, aneurysms and stenoses). They are interrelated and associated with destruction of mural architecture and concomitant loss of tensile strength (fragility) attributable to bioengineering fatigue. The complications become manifested clinically by ischemia, hemorrhage and pressure effects developing with greater frequency in association with hypertension, arteriovenous shunts or connective tissue disorders. Moreover they are produced experimentally and iatrogenically by hemodynamic means but are unexplained by other current etiological hypotheses.