The Effect of Growth and Aging on the Vascular Architecture

Atherosclerosis is a disease of medium-sized and large arteries, and as such, we will first delve into the architecture of the arterial vessel wall. We will discuss how growth necessitates changes to the structure of arteries which are not uniform throughout the arterial tree, but rather adapt to local nutritional needs and physiological factors. Vasa vasorum microvessels supply the walls of medium and large vessels with nutrients and oxygen, while the lymphatic microvessels in the blood vessel wall play crucial roles in interstitial fluid balance, lipid absorption and metabolism, and immune surveillance. An appreciation for the complexity of the blood and lymphatic microvasculature responsible for blood vessel wall nutrition, we think, is an often overlooked aspect of the pathophysiology of cardiovascular disease.