Segmental arterial mediolysis: Unrecognized cases culled from cases of ruptured aneurysm of abdominal visceral arteries reported in the Japanese literature

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

“…[3][4][5]14) Slavin concluded that SAM is an "acute" disease in his paper which reviewed 25 specimens of the SAM. 4) The evidence of this supposition is that a patient of SAM who was incidentally discovered did not show radiological abnormality 1 month previously.…”

“…Hemodynamic change in blood-flow distribution within the splanchnic arterial arcades could contribute to rapid aneurysmal enlargement or emergence of a new lesion. Considering that SAM is an "acute" disease, 4,5) close follow-up is necessary after the rupture and intervention for SAAs, once SAM is suspected. However, the hypothesis that a healed SAM lesion might transform into an FMD-like lesion and the variation of clinical features such as aneurysm reduction and recanalization in the delayed phase could explain the good outcomes of SAM that were reported in previous studies, and we can expect SAM to progress to the state of a stable and benign disease.…”

“…[3][4][5] Thirty-three percent to 44% of patients with SAM have multiple SAAs. 5,6) In addition, the angiographic findings of some patients show the presence of bead-like appearance other than aneurysms.…”

“…[3][4][5] Thirty-three percent to 44% of patients with SAM have multiple SAAs. 5,6) In addition, the angiographic findings of some patients show the presence of bead-like appearance other than aneurysms. Although histological examination is the gold standard for the diagnosis of SAM, 4) and the criteria for the clinical diagnosis of SAM are yet to be established, radiological findings sometimes contribute to the clinical diagnosis of SAM after excluding other suspected systemic diseases.…”

“…After coil embolization of the responsible arteries, an adjacent SAA showed unexpected rapid enlargement and was successfully treated with endovascular therapy. We diagnosed our patient with SAM on the basis of the presence of multiple SAAs and "acute" remodeling, 4,5) and we have also discussed the feasibility of the clinical diagnostic steps.…”