**Abstract**

In an inflammation, including appendicitis, vascular adequacy is required to supply anti-inflammatory substances and nutrition due to inflamed tissue remodeling. Normal tissue has balanced tissue regeneration and tissue destruction from apoptosis. While in inflammation, inflammatory substances tend to cause tissue destruction and lead to necrosis. This requires the tissue to increase cell regeneration to maintain tissue homeostasis in the appendix, induced mainly by oxygenation, nutrition, growth factors, and mainly anti-inflammatory substances that are obtained with vascular adequacy. This process needs active vascularization that can be achieved with neovascularization to ensure good vascularization to the tissue lacking from vascular damage. The ability of neovascularization is mainly related to growth factors acting in the endothelium and inducing neovascularization process. This mechanism is impaired in the process of inflammation by inflammatory substances causing endothelial dysfunction. As stated that vascular adequacy is related to growth factors such as vascular endothelial growth factors (VEGF) that may differ from one person to another, external and internal factors plays role in affecting individualized difference in adapting to inflammatory process, the expression of the VEGF may be a novel distinction to cut-off requirements of inflammation process in appendicitis would be self-limiting or continue to cause tissue necrosis and perforating appendicitis that urges surgical treatment to encounter the unstoppable inflammatory process in the appendix.

**Keywords:** appendicitis, endothelial dysfunction, inflammation, neovascularization, VEGF
