Segmental Arterial Mediolysis: Abdominal Imaging of and Disease Course in 111 Patients

Naidu, Sailendra; Menias, Christine O.; Öklü, Rahmi; Hines, Robert Stephan; Alhalabi, Kinan; Makar, Gerges; Shamoun, Fadi; Henkin, Stanislav; McBane, Robert D.

doi:10.2214/ajr.17.18309

Cited by 48 publications

(78 citation statements)

References 23 publications

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“…Various etiological factors for SAA have been reported, including angiodysplasia [6], segmental arterial mediolysis [18], portal hypertension [6,8], pregnant or multiparous woman [4,6], atherosclerosis [6,8], essential hypertension [8,19], diabetes mellitus [19], syphilis [6], intracranial aneurysm [19], embolic diseases [6], polyarteritis nodosa [19], α1-antitrypsin deficiency [20], and infective factors and inflammation [6,8]. Interestingly, although the SAA in this case had severe calcification, the pathology evaluation revealed no atherosclerotic changes.…”

Section: Discussionmentioning

confidence: 99%

Severely Calcified True Aneurysm: A Thought-Provoking Case of Solitary Origin and Postoperative Management

et al. 2019

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Patient: Male, 70 Final Diagnosis: Splenic artery aneurysm Symptoms: Asymptomatic Medication: — Clinical Procedure: Surgery and Endoscopy Specialty: Surgery Objective: Unknown ethiology Background: Visceral arterial aneurysms are rare. Most splenic arterial aneurysms (SAAs) are saccular and are in the distal third of the splenic artery. Suggested major causes of SAAs are atherosclerosis, pregnancy, and inflammation. We report the case of a patient who with a SAA extending almost the full length of his splenic artery. Case Report: A solitary true aneurysm that extended almost the entire length of the splenic artery was incidentally detected in an asymptomatic 70-year-old male patient with a history of myasthenia gravis and diabetes mellitus. His SAA was severely calcified, but other arteries showed no calcification. The aneurysm had been slightly enlarged toward the celiac artery for 2 years, and aneurysmectomy and splenectomy were performed. Vascular clips were carefully placed at the intact splenic artery without disturbing arterial flows from the celiac artery. Arterial branch from the SAA was ligated at an intact area, and the pancreatic capsule was densely adherent with the calcified aneurysm wall. The pancreas was preserved, although the pancreatic parenchyma was widely exposed during aneurysmectomy. Pathological examination revealed no atherosclerotic changes. Postoperatively, a pancreatic fistula developed, which was treated by placing an intraperitoneal drain and retrograde pancreatic drainage tube. Nevertheless, the intractable pancreatic fistula triggered a bacteriogenic infection, resulting in intraperitoneal abscess. Continuous local lavage via transnasal continuous infusion and endoscopic transgastric drainage was performed, until the fistula closed. He was healthy at 9 months after surgery. Conclusions: A SAA that had the rare form and solitary origin was treated. Continuous local lavage has a therapeutic potential for a pancreatic juice-related bacteriogenic complication.

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Section: Discussionmentioning

confidence: 99%

Severely Calcified True Aneurysm: A Thought-Provoking Case of Solitary Origin and Postoperative Management

et al. 2019

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“… 8 , 9 Commonly affected vascular territories are the celiac, mesenteric, and renal arteries, although central nervous system presentations have also been reported. 10 , 11 Epidemiological data indicate that there is a slight male preponderance, with presentation typically between the fifth to sixth decades of life. 10 However, as patients may sustain silent infarcts or have asymptomatic disease progression, SAM may in fact have an earlier age of onset.…”

Section: Discussionmentioning

confidence: 99%

“… 10 , 11 Epidemiological data indicate that there is a slight male preponderance, with presentation typically between the fifth to sixth decades of life. 10 However, as patients may sustain silent infarcts or have asymptomatic disease progression, SAM may in fact have an earlier age of onset. Presentations of SAM vary depending on the affected vascular territories, as well as the extent of involvement.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Segmental Arterial Mediolysis, a Rare Cause of Hypertension

Rasuli

Burns

2020

Can J Kidney Health Dis

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Rationale: The differential diagnosis for hypertension with elevated plasma renin is broad. This case illustrates one of the rarer, and therefore underrecognized, causes of high renin hypertension. Presenting concerns of the patient: A 41-year-old man with a medical history significant for multiple ischemic strokes and dyslipidemia presented for assessment of decreased renal function and resistant hypertension. His initial workup for secondary causes of hypertension was remarkable for an elevated plasma renin and normal aldosterone. Further investigation with computed tomography (CT) angiography was performed, which demonstrated multiple bilateral renal aneurysms and infarcts. Diagnoses: After ruling out other potential causes of bilateral renal aneurysms and infarcts, a diagnosis of segmental arterial mediolysis (SAM) was made. Interventions: Optimization of antihypertensive regimen, counseling regarding regular home blood pressure monitoring, and smoking cessation. Outcomes: The patient achieved excellent blood pressure control, stable renal function, and had no further strokes or other vascular events. Teaching points: Our case demonstrates the importance of considering SAM in the diagnosis of hypertension with elevated plasma renin and as a vasculitis mimic. It also highlights the importance of considering renal vascular imaging in the workup of resistant hypertension.

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“…Arterial dissections account for the majority of the reported cases of SAM, followed by pseudoaneurysms. When dissection of peripheral arteries unrelated to the aorta is observed, a diagnosis of SAM should be considered [5,7,8].…”

Section: Discussionmentioning

confidence: 99%

“…Naidu et al [8] and Michael et al [9] have shown that CTA provides the spatial resolution and vessel detail required for the acute diagnosis of SAM. Serial CTA is found to be superior to conventional angiography, as it able to evaluate perivascular inflammation, vessel wall thickening, and rapidly evolving lesions [9].…”

Section: Discussionmentioning

confidence: 99%

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

Tan

2019

VSI

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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.

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Segmental Arterial Mediolysis: Abdominal Imaging of and Disease Course in 111 Patients

Abstract: SAM most commonly affects the renal arteries, superior mesenteric artery, and celiac artery. Dissections and aneurysms are the most common imaging findings. Follow-up imaging studies show stability or regression in most patients.

Cited by 48 publications

References 23 publications

Severely Calcified True Aneurysm: A Thought-Provoking Case of Solitary Origin and Postoperative Management

Severely Calcified True Aneurysm: A Thought-Provoking Case of Solitary Origin and Postoperative Management

Case Report: Segmental Arterial Mediolysis, a Rare Cause of Hypertension

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

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