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October 1949


Arch Intern Med (Chic). 1949;84(4):558-568. doi:10.1001/archinte.1949.00230040037004

REPEATED attempts have been made to ascertain the underlying etiologic factors in idiopathic cystic necrosis of the aorta since it was first described by Gsell1 and by Erdheim.2 Workers have pursued several courses, among which have been the morphologic and the experimental. Among the former, the work of Erdheim is still fundamental and outstanding. He noted specifically the absence of vasa vasorum at the site of rupture in those instances in which the aorta showed the typical picture of medial necrosis. In other cases, he observed some degree of hyalinization. Despite his observations and the later work of Wiese,3 he stated the belief that the vasa vasorum did not play a role in the production of medionecrosis of the aorta. He favored the idea of some form of hyperadrenalism as the possible etiologic factor. Later workers4 noted alterations of the vasa vasorum.

Attempts to reproduce the

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