ELN and achalasia-alacrima syndrome: Several pathogenic mechanisms have been implicated in aortic aneurysm formation and expansion including local inflammation,8 extracellular matrix (ECM) remodelling,9–12 increased elastolysis,8 and oxidative stress.13 Elastin is an abundant ECM protein of the aortic wall, the remodelling of which is crucial for the progression of AAAs.9,10,12 Elastin is formed by cross-linking of the 72 kDa soluble precursor tropoelastin molecule,14 by lysyl oxidase (LOX).