Nonatherosclerotic Abdominal Vasculopathies

Skeik, Nedaa; Hyde, Jonathan R.; Olson, Sydney L.; Thaler, Christina; Abuatiyeh, Wala; Ahmed, Aisha; Lyon, Danielle R.; Witt, Dawn; Garberich, Ross; Sullivan, Timothy M.

doi:10.1016/j.avsg.2019.04.004

Cited by 17 publications

(14 citation statements)

References 47 publications

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“…Similarly, an elevated ESR and CRP may often be observed with organ infarction and should not solely be used to exclude a diagnosis of SAM. 12,13 Kaneko et al recently described a rare case of SAM coexisting with scleroderma. 14 Treatment of SAM includes conservative therapy with antiplatelet therapy, optimal blood pressure control, 6 and endovascular interventions.…”

Section: Discussionmentioning

confidence: 99%

Segmental Arterial Mediolysis: A Vasculitis Mimic

Bilal

Alkhatib

Solow

et al. 2019

J Clin Interv Radiol ISVIR

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Background Segmental arterial mediolysis (SAM) is a rare noninflammatory vasculopathy. The purpose of this report is to describe the clinical data of six patients diagnosed with SAM, discuss key elements for diagnosis, and highlight the differences between SAM and vasculitis. We also propose a modification to the criteria developed by Kalva et al for the diagnosis of SAM. Methods This is a retrospective study approved by the Institutional Review Board and included patients diagnosed with SAM between January 2008 and December 2016. Eleven patients were identified, of whom six (four males with a median age of 59.5 years) had complete data per the guidelines proposed by Kalva et al and were thus included. Data on patient’s clinical presentation, laboratory and imaging findings, and outcomes were collected. Results Presenting symptoms included abdominal pain, flank pain, and bloody stools. Five patients had negative antinuclear antibodies (ANAs) and one had positive ANAs with negative subserologies. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were normal except for an elevated CRP in two patients with organ infarction. The superior mesenteric and renal arteries were most commonly involved. The most common vascular abnormalities were dissection, pseudoaneurysm, thrombosis, and wall thickening. Two patients received endovascular repair for hepatic artery aneurysms. During the follow-up (range: 3–36 months), two patients developed a new aneurysm or dissection. Conclusion The long-term prognosis of SAM appears to be favorable. Vascular intervention is only needed for patients with impending vascular compromise. We propose that the criteria developed by Kalva et al could be modified to include patients with elevated ANA but negative subserologies and elevated CRP and ESR in the presence of organ infarction.

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Section: Discussionmentioning

confidence: 99%

Segmental Arterial Mediolysis: A Vasculitis Mimic

Bilal

Alkhatib

Solow

et al. 2019

J Clin Interv Radiol ISVIR

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“…[11,12] This makes adequate diagnosis, by means of visceral angiography, and subsequent (interventional) treatment necessary. [13] 4. CONCLUSION Spontaneous rupture of the splenic artery due to PAN is extremely rare.…”

Section: Discussionmentioning

confidence: 99%

Polyarteritis nodosa: An unusual cause of life-threatening intra-abdominal bleeding

Verdonk

Jonkman

Dees

2019

CRIM

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Intra-abdominal arterial bleeding is a life-threatening condition, warranting immediate causal therapy. Polyarteritis nodosa is a rare type of necrotizing vasculitis that affects medium-sized arteries. We present a patient with severe arterial bleeding as the first symptom of polyarteritis nodosa. Because the bleeding took place intra-abdominal instead of gastro-intestinal, there was no macroscopic blood loss. She was successfully treated with endovascular coil embolization during angiography.

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“…Hereditary connective tissue disease. Genetic disorders resulting in arterial aneurysms were lower in the differential since this was the patient's first presentation of such symptoms without any history of previous complications at a younger age (5). Ehlers-Danlos syndrome type IV, which is the vascular type of this condition (mutation of the type III procollagen COL3A1), was an unlikely cause of the patient's symptoms as he lacked the clinimanifestations of easy bruising, thin skin with visible veins, and characteristic facial features typically observed in this condition (6).…”

Section: Primary or Secondary Large And Medium Vessel Systemic Vasculitismentioning

confidence: 99%