Clinical study
Segmental Arterial Mediolysis: Clinical and Imaging Features at Presentation and during Follow-up

https://doi.org/10.1016/j.jvir.2011.07.001Get rights and content

Abstract

Purpose

To review clinical and imaging features at presentation and during follow-up of patients with a suspected diagnosis of segmental arterial mediolysis (SAM).

Materials and Methods

All cases of SAM diagnosed at a single institution from 2000 to 2010 were included. Diagnosis was based on characteristic radiologic features in the absence of other plausible diagnoses. Medical records were reviewed for demographics, presenting symptoms, and laboratory and imaging findings at presentation and during follow-up.

Results

Fourteen patients (nine men; mean age, 53 y ± 15) were diagnosed with SAM. Initial presentation included abdominal or flank pain (n = 8) and chest pain, headache, stroke, or suprapubic fullness (n = 1 each). Two patients were asymptomatic. Inflammatory markers were negative in all cases. Imaging at presentation revealed involvement of celiac (n = 7), common hepatic (n = 3), splenic (n = 2), superior mesenteric (n = 5), renal (n = 5), and iliac (n = 2) arteries and the abdominal aorta (n = 1). Imaging demonstrated arterial dissections (n = 10), fusiform aneurysms (n = 6), arterial wall thickening (n = 2), and artery occlusion (n = 1). Clinical follow-up was available in 13 patients (median, 25 mo). Symptoms improved (n = 4), resolved (n = 3), or remained stable (n = 2), and four patients experienced new symptoms. Follow-up imaging, available in 10 patients at a median of 33 months, demonstrated new dissections, aneurysms, or arterial occlusions in five patients, including carotid artery dissection in three. Imaging findings remained stable (n = 3), improved (n = 1), or resolved (n = 1).

Conclusions

SAM affects middle-aged and elderly patients. Visceral artery dissections and aneurysms are common. The disease progresses in nearly half the patients. Serial follow-up with computed tomographic angiography and/or magnetic resonance angiography may be necessary to monitor disease progression.

Section snippets

Materials and Methods

This retrospective study was approved by the institutional review board and was compliant with the Health Insurance Portability and Accountability Act. The review board waived the requirement to obtain informed consent from the study subjects for inclusion in this study.

Clinical Presentation

Abdominal pain was the most common clinical presentation (Table 2). Seven of the 14 patients (50%) presented with abdominal pain, four with an acute abdomen, and three with chronic abdominal pain. Other symptoms included flank pain, chest pain, headache, stroke with hemiparesis, and suprapubic fullness in one patient each. Two patients were asymptomatic: the imaging findings characteristic of SAM were identified on imaging performed for follow-up of renal cell cancer in one patient and

Discussion

The incidence of SAM is unknown but is probably underestimated (7). The disease affects middle-aged and elderly patients with no male or female predilection. The splanchnic vessels are most commonly involved. However, involvement of the carotid, renal, intracranial, and iliac arteries has been reported (5). The pattern of vascular involvement varies with age; cerebral vasculature is more commonly involved in young patients (8), whereas the coronary arteries are commonly involved in neonates and

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  • Cited by (0)

    None of the authors have identified a conflict of interest.

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