Syphilitic aortitis is a disease of the aorta

Aorta

The aorta is the largest artery in the body, originating from the left ventricle of the heart and extending down to the abdomen, where it branches off into two smaller arteries...

 associated with the tertiary stage of syphilis

Syphilis

Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...

 infection. SA begins as inflammation of the adventia, including the vessels that supply the aorta itself with blood, the vasa vasorum

Vasa vasorum

The vasa vasorum is a network of small blood vessels that supply large blood vessels.The vasa vasorum are found in large arteries and veins such as the aorta and its branches....

. As it worsens, the vasa vasorum show hyperplastic thickening of their walls that restricts blood flow and causes ischemia

Ischemia

In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...

 of the outer two-thirds of the aortic wall. Starved for oxygen and nutrients, elastic fibers become patchy and smooth muscle cells necrose. The wall weakens and scars. If the disease progresses, syphilitic aortitis

Aortitis

-Causes:This inflammation has a number of possible causes, to include: trauma, viral infection, certain immune disorders, and bacterial infection .-Treatment:...

 leads to an aortic aneurysm

Aortic aneurysm

An aortic aneurysm is a general term for any swelling of the aorta to greater than 1.5 times normal, usually representing an underlying weakness in the wall of the aorta at that location...

.

Overview

Inflammatory involvement of tertiary syphilis begins at the adventitia of the aortic arch which progressively causes obliterative endarteritis of the vaso vasorum. This then causes narrowing of the lumen of the vaso vasorum, causing ischemic injury of the medial aortic arch and then finally loss of elastic support and dilation of the vessel. Dissection of the aortic arch is rare due to medial scarring. As a result of this advanced disease process, standard methods of angiography/angioplasty may be impossible for those with suspected coronary heart disease but patients are able to undertake diagnostic CT of coronary arteries without physical intervention to coronary arteries. This disorder is also known eponymously as Heller-Döhle syndrome.