Acute Remodeling of an Adjoining Aneurysm after Endovascular Treatment of a Ruptured Splanchnic Arterial Aneurysm: A Case of Clinically Diagnosed Segmental Arterial Mediolysis

Nishikawa, Yoshitaka; Hoshina, Katsuyuki; Sasaki, Hiroki; Hosaka, Akihiro; Yamamoto, Kota; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro

doi:10.3400/avd.cr.12.00060

Cited by 16 publications

(12 citation statements)

References 15 publications

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“…reports described that VAAs caused by SAM may occur heterotypically or heterochronically. [11][12][13] In this case, approximately 1 year after surgery, there is no recurrence of the aneurysm visible. Close follow-up is required to verify the recurrence of the aneurysms.…”

Section: Discussionmentioning

confidence: 94%

Pancreaticoduodenal Artery Pseudoaneurysm Caused by Segmental Arterial Mediolysis: A Case Report of Surgical Treatment

Ushijima

Izumo

Matsumoto

et al. 2013

Annals of Vascular Diseases

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A 64-year-old woman underwent surgical resection of a posterior inferior pancreaticoduodenal arterial aneurysm in the subacute phase of acute aortic dissection (AAD). Concomitantly, a distal pancreatectomy was also required. The aneurysm was approximately 20 mm in diameter. Surgical resection of the aneurysm was performed because endovascular treatment was considered to be technically difficult due to dissecting lesions that had remained at the abdominal aorta. Histopathological findings suggested this aneurysm to be a pseudoaneurysm, which had arisen as a result of segmental arterial mediolysis. Approximately 1 year after surgery, no recurrence of the aneurysms was detected.

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Section: Discussionmentioning

confidence: 94%

Pancreaticoduodenal Artery Pseudoaneurysm Caused by Segmental Arterial Mediolysis: A Case Report of Surgical Treatment

Ushijima

Izumo

Matsumoto

et al. 2013

Annals of Vascular Diseases

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“…Reported methods for diagnosing SAM. (A) A total of 121 cases were identified from the 66 case reports 4,5,8–10,13,22–81 with unique diagnostic strategies. For publications detailing multiple patients, a case was counted as unique if the diagnostic strategy was specifically based on that patient’s presentation and was considered redundant and only recorded once if the same strategy was applied to multiple patients in the report.…”

Section: Discussionmentioning

confidence: 99%

Segmental arterial mediolysis (SAM): Systematic review and analysis of 143 cases

et al. 2019

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Segmental arterial mediolysis (SAM) is a rare but serious nonatherosclerotic, noninflammatory vasculopathy of unknown etiology that often results in dissection, aneurysm, occlusion, or stenosis of, primarily, the abdominal arteries. Current literature lacks consensus on diagnostic criteria and management options for SAM. This review summarizes 143 cases and aims to advance appropriate recognition and management of SAM. Literature review of all relevant SAM case studies from 2005 to 2018 yielded 126 individual SAM cases from 66 reports. We identified 17 additional SAM cases from our center, bringing our analysis to 143 patients. Patients with SAM were most commonly men (68%) in their 60s. Hypertension (43%), tobacco use (12%), and hyperlipidemia (12%) were common comorbidities. Abdominal pain (80%) and intraabdominal bleeding (50%) were the most common presenting symptoms. Computed tomography was the most frequently used imaging method (78%), and histology was available in 44% of cases. The most commonly affected vessels were the superior mesenteric (53%), hepatic (45%), celiac (36%), renal (26%), and splenic (25%) arteries with aneurysm (76%), dissection (61%), and arterial rupture (46%). Treatments included coil embolization (28%), abdominal organ surgery (24%), open arterial repair (21%), and medical management (20%). Case-specific treatment modalities yielded symptom relief in the vast majority (91%) of patients, with a mortality rate of 7%.

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“…6, a new aneurysm emerged after the coil embolization for the initial aneurysm and remodeling represented the specific “acute” feature of SAM. 18,19) As this tissue disorder should ideally be diagnosed based on pathological results, PDA patients with SAM or fibromuscular dysplasia may have potentially existed. We should suspect a comorbid disease when we come across patients with PDAA without CA lesions or when aneurysms emerge in succession.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Simulation of Pancreaticoduodenal Artery Aneurysm Formation Using an Electronic Circuit Model and a Case Series Analysis

Miyahara

Hoshina

Nitta

et al. 2019

Annals of Vascular Diseases

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Objective : To assess mechanisms underlying aneurysm formation using a simple electronic circuit model. Materials and Methods : We created a simple circuit model connecting the celiac artery (CA) to the superior mesenteric artery via the pancreaticoduodenal arcade. We retrospectively reviewed 12 patients with true pancreaticoduodenal artery aneurysms (PDAAs) who received open or endovascular treatment between 2004 and 2017. We set the resistance of each artery and organ voltage and calculated flow volume and rate in response to degrees of simulated CA stenosis from 0% to 99.9%. Results : Flow volume rates of the anterior pancreaticoduodenal artery and posterior pancreaticoduodenal artery decreased to zero when CA stenosis increased from 0% to 50% and then increased drastically, at which point flow direction reverted and the flow was up to three times the initial rate. The gastroduodenal artery (GDA) also showed reversed flow with severe CA stenosis. In 12 patients with PDAA, eight presented with a CA lesion, and the other patients presented with comorbidities causing the arteries to be pathologically fragile, such as Marfan syndrome, Behçet’s disease, and segmental arterial mediolysis. All four GDA aneurysms were not accompanied by CA lesions. Conclusion : The mechanism underlying CA-lesion-associated PDAA formation may be partially explained using our model.

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Acute Remodeling of an Adjoining Aneurysm after Endovascular Treatment of a Ruptured Splanchnic Arterial Aneurysm: A Case of Clinically Diagnosed Segmental Arterial Mediolysis

Cited by 16 publications

References 15 publications

Pancreaticoduodenal Artery Pseudoaneurysm Caused by Segmental Arterial Mediolysis: A Case Report of Surgical Treatment

Pancreaticoduodenal Artery Pseudoaneurysm Caused by Segmental Arterial Mediolysis: A Case Report of Surgical Treatment

Segmental arterial mediolysis (SAM): Systematic review and analysis of 143 cases

Hemodynamic Simulation of Pancreaticoduodenal Artery Aneurysm Formation Using an Electronic Circuit Model and a Case Series Analysis

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