Endothelial dysfunction in aortic aneurysm and dissection pathogenesis

Aortic aneurysm and dissection (AAD) represent catastrophic vascular conditions with high mortality rates. Currently, non-surgical therapeutic options remain limited, while surgical intervention entails significant risk. As the second most common aortic disease after atherosclerosis and the ninth leading cause of death worldwide, aortic dissection involves separation of the parietal layer caused by intimal tear or intramural hemorrhage. Endothelial dysfunction is an important participant and amplifier in the early onset of AAD. Most cases begin with intimal injury in which endothelial injury plays a contributing role and are characterized by increased permeability, inflammatory infiltration, and disrupted intercellular junctions. This process compromises vessel wall integrity and initiates a complex cascade of reactions that ultimately lead to AAD. Therefore, discussing the localization of the role of endothelial cells in the early stage of aortic disease, and based on this analysis of possible therapeutic targets and directions, is of great significance for understanding the initial events associated with AAD.