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In page Syphilitic aortitis:

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Inflammatory involvement of tertiary syphilis begins at the adventitia of the aortic arch which progressively causes obliterative endarteritis of the vasa vasorum.[1] This leads to narrowing of the lumen of the vasa vasorum, causing ischemic injury of the medial aortic arch and then finally loss of elastic support and dilation of the vessel.[1] Dissection of the aortic arch is rare due to medial scarring. As a result of this advanced disease process, normal methods of angiography/angioplasty may be impossible for those with suspected coronary artery disease.[citation needed]