Segmental Arterial Mediolysis: A Case Study and Review of the Literature in Accurate Diagnosis and Management

Abstract

Segmental arterial mediolysis (SAM) is a rare noninflammatory, nonarteriosclerotic arteriopathy of an unknown etiology. It most commonly affects the medium-sized vessels of the abdomen and is characterized by the disruption of the arterial medial layer. Although histological confirmation remains the gold standard in diagnosis, the use of computed tomography angiography (CTA) has greatly aided the diagnosis and surveillance of SAM. Given its rarity and angiographic similarities to other vasculopathies, the diagnosis of SAM can be challenging and is often missed. We describe the case of a 46-year-old male patient who presented to our institution with abdominal pain and multiple foci of intra-abdominal arterial dissections on CTA. We report the acute management via endovascular intervention and review the literature with respect to the diagnosis and management of this rare condition. SAM remains an uncommon yet significant disease process requiring prompt and accurate diagnosis. Initiation of immediate treatment is crucial, given the knowledge gap about its natural progression.

Hepatic segmental arterial mediolysis: A case report and brief literature review

“…9 Differential diagnosis of this disease is very important, as there are multiple mimics that could make diagnosing SAM particularly challenging. 2,5,7,9,13 Atherosclerosis as a cause needs to be considered, but patients usually have diffuse atherosclerosis of multiple vessels, and the disease affects artery bifurcations. 5 SAM is usually isolated in medium sized vessels and has no preference for bifurcations.…”

“…3,[8][9][10][11] However, the disease has been reported in all age groups, including neonates. 3,5 No comorbidities have been associated with SAM 3 , but most studies, reported hypertension in a significant number of patients with the disease. 2,3 However, it is possible that this finding reflects the incidence of hypertension in this population.…”

Segmental Arterial Mediolysis of the Abdominal Vessel: A Case Report

“…The hallmark of angiographic diagnosis is stenosis, occlusion, aneurysmal formation, arterial dilatation, and dissection of medium-sized vessels. Numerous lesions are often identified, affecting arteries in a segmental skip pattern, with the diseased segments demonstrating the involvement of the circumference or only a portion of the arterial wall (5). Arterial dissections account for most of the reported cases of SAM, followed by pseudoaneurysms.…”

Clinically Suspected Segmental Arterial Mediolysis of the Splanchnic Arteries: A Report of 2 Rare Cases

“…Due to the nonspecific clinical presentation, SAM can mimic different pathologies and conditions, including atherosclerosis alterations, systemic inflammatory vasculitis such as granulomatosis with polyangiitis, polyarteritis nodosa, eosinophilic granulomatosis with polyangiitis, Kawasaki disease or Takayasu’s arteritis, mycotic aneurysm, cystic medial necrosis (in patients with Marfan Syndrome), fibromuscular dysplasia, and infectious processes. Epidemiological, laboratory, histology, and radiological findings need to be carefully analyzed and integrated to obtain the correct diagnosis and to guide the treatment [ 21 , 22 ]. The natural history of SAM is unpredictable and requires continued surveillance over several years.…”