Extensive Cerebrovascular and Visceral Artery Dissection and Pseudoaneurysm with Underlying Segmental Arterial Mediolysis

Sethi, Abhishek; Hyde, Jonathan R.; Thaler, Christina; Skeik, Nedaa

doi:10.1016/j.avsg.2017.04.044

Cited by 9 publications

(15 citation statements)

References 23 publications

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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%

“…11,12 One patient also had a pathological finding consistent with SAM, including lysis of the outer arterial media resulting in separation of the media from the adventitia leading to dissecting pseudoaneurysms. 3,4,13 To exclude isolated idiopathic or trauma-related lesions, we required multiple vessel involvement to diagnose SAM. The presence of more severe wall thickening and/or elevated inflammatory markers are more indicative of LVGT or polyarteritis nodosa (PAN), and therefore were used as exclusionary markers.…”

Section: Methodsmentioning

confidence: 99%

“…A total of 126 unique cases were identified from 66 different case reports and case studies (Supplementary Table 1). 4,5,8–10,13,22–81…”

Section: Methodsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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“…1 The hallmark finding is vacuolization of the smooth muscle cells in the outer media layer, subsequently leading to separation at the mediaadventitia junction. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] It most frequently affects the visceral and renal arteries in patients in their fifth to sixth decades of life, with slight predilection for the male sex; isolated case reports have demonstrated similar histopathologic findings in the coronary arteries of neonates and cerebral arteries of younger patients. 2,5,6,9,11,12 Patients present with symptoms according to the affected vascular bed.…”

mentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] It most frequently affects the visceral and renal arteries in patients in their fifth to sixth decades of life, with slight predilection for the male sex; isolated case reports have demonstrated similar histopathologic findings in the coronary arteries of neonates and cerebral arteries of younger patients. 2,5,6,9,11,12 Patients present with symptoms according to the affected vascular bed. Involvement of the visceral or renal vessels is most common and typically is manifested as abdominal pain.…”

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confidence: 99%