Medical College of Wisconsin
CTSICores SearchResearch InformaticsREDCap

A Single Center 8 Year Experience of Segmental Arterial Mediolysis Management. Ann Vasc Surg 2022 Apr;81:273-282

Date

11/15/2021

Pubmed ID

34775009

DOI

10.1016/j.avsg.2021.09.045

Scopus ID

2-s2.0-85120638064   1 Citation

Abstract

OBJECTIVE: Segmental Arterial Mediolysis (SAM) is a rare, poorly understood vasculopathy that involves vacuolization of the arterial wall, most commonly of the visceral arteries. There are no established therapeutic or monitoring guidelines for SAM, and intervention typically depends on patient presentation. The purpose of this study is to review the management and outcomes of patients with this rare vascular disease METHODS: Single center retrospective review of patients diagnosed with SAM between 2011 and 2019. Included were patients with radiological diagnosis of SAM. Demographic factors, past medical history, presenting symptoms, affected vessels, management, and lesion characteristics over time were collected. Demographic and periprocedural factors, and medical management strategies were compared for those who required operative intervention versus those managed non-operatively.

RESULTS: Thirty patients were included, 21 (70%) were male, mean age was 53.5 years (range: 35.7-72.2). Twenty-seven patients were managed non-operatively, 3 patients required surgical intervention. Patients who underwent operative intervention were more likely to present with pain >30 days (P < 0.05), and hemorrhage (P < 0.01). Abdominal pain was the most common presenting symptom (n = 24, 80%). Arterial dissection was the most common radiological finding at time of presentation (n = 20, 67%). The celiac artery and its branches were most often involved (n=22, 73%) followed by the superior mesenteric artery and its branches (n = 15, 50%). Non-operative management most often consisted of anti-hypertensive therapy (n = 13, 43%), antiplatelet agents (n = 17, 57%%), and lipid-lowering agents (n = 13, 43%), with 7 patients receiving all three. Six patients demonstrated confirmed resolution of lesions during surveillance imaging, with average time to resolution of 325.5 days.

CONCLUSIONS: Patients who underwent intervention for SAM presented with either mesenteric ischemia or pseudoaneurysm rupture. In patients that present without those conditions, medical management consisting of anti-hypertensives, antiplatelet agents, and lipid-lowering therapy was effective. Non operative management resulted in symptom resolution in all patients and surveillance imaging showed resolution of radiographic abnormalities in 6 patients out of 27 at less than one year.

Author List

Srinivasan A, Olowofela A, Rothstein A, Brown KR, Malinowski MJ, Hart JP, Rossi PJ, Lewis BD, Mansukhani NA

Authors

Joseph Hart MD Associate Professor in the Surgery department at Medical College of Wisconsin
Brian D. Lewis MD Professor in the Surgery department at Medical College of Wisconsin
Michael Malinowski MD Associate Professor in the Surgery department at Medical College of Wisconsin
Peter J. Rossi MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Abby Rothstein MD Assistant Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Celiac Artery
Female
Humans
Male
Mesenteric Artery, Superior
Mesenteric Ischemia
Middle Aged
Treatment Outcome