Adventitial adipogenic degeneration is an unidentified contributor to aortic wall weakening in the abdominal aortic aneurysm

Although it is assumed AAA progression is driven by a proteolytic imbalance and inflammation, clinical studies consistently fail to show a benefit of medical interventions targeting these pathways. In this context, we sought further, currently unidentified mechanisms involved in (terminal) AAA wall weakening. This translational study identifies extensive adventitial fatty degeneration as a distinctive feature of advanced AAA disease. Enrichment of adipocyte-related genes in ruptured AAA wall samples implies an association between the extent of fatty degeneration and rupture.