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Role of Hemodynamics

Spiros G. Frangos, MD; Vivian Gahtan, MD; Bauer Sumpio, MD, PhD

Arch Surg. 1999;134:1142-1149.

Atherosclerosis is a chronic disease attributed to risk factors that are systemic in nature. Yet the lesions involved do not occur in random fashion. The coronary arteries, the major branches of the aortic arch, and the abdominal aorta and its visceral and major lower extremity branches are particularly susceptible sites. Hemodynamic forces interacting with an active vascular endothelium are responsible for localizing lesions in a nonrandom pattern of distribution. Shear stress and cyclic circumferential strain are the predominant forces that have been characterized. The modification of endothelial cell structure and function by these mechanical forces sheds insight into the vasculature's propensity for atherogenesis.

From the Department of Surgery (Dr Frangos) and the Section of Vascular Surgery (Drs Gahtan and Sumpio), Yale University School of Medicine, New Haven, Conn.

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