Redox Dysregulation in the Abdominal Aortic Aneurysm Wall: Ferroptosis and Experimental Therapeutic Opportunities

Abdominal aortic aneurysm (AAA) is a spatially heterogeneous disease of the aortic wall for which no pharmacological treatment has reliably arrested enlargement. The term oxidative stress encompasses processes that differ in chemical form, anatomical location and cellular effect. This narrative review examines haem and redox-active iron, phospholipid peroxidation and antioxidant defence at the intraluminal thrombus-wall interface and within medial and inflammatory cells. We distinguish ferroptosis from redox effects on coagulation, migration and secretion and relate these functions to wall remodelling. Experimental studies show that manipulating iron uptake and ferritin turnover, membrane phospholipid susceptibility or peroxide detoxification can alter vascular smooth muscle cell survival, macrophage behaviour and aortic injury. The cellular function affected helps determine which process an intervention should preserve or suppress. Based on evidence from human tissue and animal models, we review opportunities to localise, manipulate and monitor these processes and assess their relevance to established AAA. Testing after confirmation of aneurysm formation, with target engagement in defined wall cells and parallel assessment of systemic effects, is needed to determine whether these approaches can limit continued enlargement.