Typically affects those under the age of 50 and die of Heart failure induced by aortic valvular incompetence. Vasa vasorum show hyperplastic that thickness of their walls that block the blood flow and causes ischemia of the outer two-thirds of the aortic wall. Starved for O2/ nutrients, elastic fibers become patchy and smooth muscle cells necrose. Media scars. If the disease progresses, syphilitic aortitis leads to an aortic aneurysm.