Natural history and management outcomes of segmental arterial mediolysis

Peng, Kate; Davila, Victor J.; Stone, William M.; Shamoun, Fadi; Naidu, Sailendra; McBane, Robert D.; Money, Samuel R.

doi:10.1016/j.jvs.2019.02.068

Cited by 22 publications

(75 citation statements)

References 30 publications

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“…However, the reported mortality varies widely, as other studies have described mortality rates as high as 50% in patients with acute hypotension secondary to SAM [9]. This large disparity in mortality rates has been attributed to recent improvements in diagnostic and therapeutic techniques in a current review [10], as well as the inherent reporting bias wherein only cases involving the most severe forms of rare diseases, such as SAM, tend to be reported [3]. Therefore, few reports have described cases of visceral aneurysm rupture that presented with a relatively slow clinical course, as in our case.…”

Section: Discussionmentioning

confidence: 95%

“…The most commonly involved vessel was the celiac artery, including the celiac axis and its branches. Overall, 4.3% of patients in that study died, although only one death was SAM-related [ 3 ]. However, the reported mortality varies widely, as other studies have described mortality rates as high as 50% in patients with acute hypotension secondary to SAM [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…SAM is a nonatherosclerotic, and noninflammatory disease of the arterial media that often involves multiple vessels [2]. In such cases, the clinical course following a rupture may vary depending on the involved vessels [3]. For example, the rupture of a splenic artery aneurysm exhibits a biphasic and relatively slow clinical course described as the "double-rupture phenomenon" [4].…”

Section: Introductionmentioning

confidence: 99%

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Biphasic clinical course of a ruptured right gastric artery aneurysm caused by segmental arterial mediolysis: a case report

et al. 2020

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Background: Gastric artery aneurysms are rarely caused by segmental arterial mediolysis (SAM), a condition that often involves multiple vessels. The clinical course of SAM after vessel rupture may vary depending on the involved vessels. For example, the "double-rupture phenomenon" observed following the rupture of the splenic artery aneurysm manifests as a biphasic and relatively slow clinical course. Even in cases of rupture of gastric artery aneurysm, the double-rupture phenomenon has only been reported in two cases so far. However, the rupture was not caused by SAM in either case. Herein, we present the apparent first case of a right gastric artery (RGA) aneurysm rupture caused by SAM that presented with a biphasic clinical course, possibly due to the double-rupture phenomenon. Case presentation: A 54-year-old woman was transferred to the emergency department with severe abdominal pain and a cold sweat for a duration of 3 h. She had developed mild abdominal pain and nausea 3 days earlier. Her vital signs were stable. Physical examination revealed tenderness in the epigastric area. Abdominal contrastenhanced computed tomography revealed an RGA aneurysm with contrast media extravasation. A diagnosis of hemoperitoneum following a ruptured RGA aneurysm was made, and the patient underwent angiography. However, this modality did not reveal any extravasation from the RGA due to an interruption in the peripheral branch of the artery. Nevertheless, to prevent major bleeding, we performed coil embolization at the point of interruption in the RGA, which we suspected to be a ruptured aneurysm. A distal gastrectomy with Roux-en-Y reconstruction for aneurysm resection was performed the following day. There were no postoperative complications, and the patient was discharged 17 days after surgery. Histologically, the RGA demonstrated multiple vacuoles in the medial muscle layer, which were characteristic of SAM. Conclusions: An RGA aneurysm rupture should be considered a differential diagnosis in patients presenting with hemoperitoneum with a slow or biphasic clinical course.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biphasic clinical course of a ruptured right gastric artery aneurysm caused by segmental arterial mediolysis: a case report

et al. 2020

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“…78 In the largest series of hypertensive cases published, the specific underlying arterial lesion was not documented. The commonest radiological findings in this cohort were dissection, focal stenosis, beading, and occlusion, 73 all of which can cause hypertension if renal arteries are involved. Additional case reports of SAM document hypertension due to renal arterial dissection.…”

Section: Segmental Arterial Mediolysismentioning

confidence: 87%

Beyond Atherosclerosis and Fibromuscular Dysplasia: Rare Causes of Renovascular Hypertension

et al. 2021

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Renovascular hypertension is one of the most common forms of secondary hypertension. Over 95% of cases of renovascular hypertension are due either to atherosclerosis of the main renal artery trunks or to fibromuscular dysplasia. These two causes of renal artery stenosis have been extensively discussed in recent reviews and consensus. The aim of the current article is to provide comprehensive and up-to-date information on the remaining causes. While these causes are rare or extremely rare, etiologic and differential diagnosis matters both for prognosis and management. Therefore, the clinician cannot ignore them. For didactic reasons, we have grouped these different entities into stenotic lesions (neurofibromatosis type 1 and other rare syndromes, dissection, arteritis, and segmental arterial mediolysis) often associated with aortic coarctation and other arterial abnormalities, and nonstenotic lesions, where hypertension is secondary to compression of adjacent arteries and changes in arterial pulsatility (aneurysm) or to the formation of a shunt, leading to kidney ischemia (arteriovenous fistula). Finally, thrombotic disorders of the renal artery may also be responsible for renovascular hypertension. Although thrombotic/embolic lesions do not represent primary vessel wall disease, they are characterized by frequent macrovascular involvement. In this review, we illustrate the most characteristic aspects of these different entities responsible for renovascular hypertension and discuss their prevalence, pathophysiology, clinical presentation, management, and prognosis.

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“…Visceral artery aneurysms (VAAs), or true aneurysms, are an uncommon entity, with a variable incidence at autopsy finding from 0.01 to 0.2% [ 1 , 2 ]. Several diseases are implicated in vascular damage with possible formation of VAAs, such as atherosclerosis, hypertension [ 3 ], medial degeneration [ 4 ], arteritis [ 5 , 6 ], infection [ 7 ], fibromuscular dysplasia [ 8 ], diabetes [ 9 ], and congenital anomalies such Ehlers-Danlos syndrome [ 10 ]. VAAs usually affect the celiac trunk, the superior mesenteric and inferior mesenteric arteries and their branches, with the splenic artery involved in up to 60% of cases, followed by the hepatic artery [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

Venturini

Piacentino

Coppola

et al. 2021

JCM

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Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator’s experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed.

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Natural history and management outcomes of segmental arterial mediolysis

Cited by 22 publications

References 30 publications

Biphasic clinical course of a ruptured right gastric artery aneurysm caused by segmental arterial mediolysis: a case report

Biphasic clinical course of a ruptured right gastric artery aneurysm caused by segmental arterial mediolysis: a case report

Beyond Atherosclerosis and Fibromuscular Dysplasia: Rare Causes of Renovascular Hypertension

Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

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