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Segmental arterial mediolysis

Anil Kumar Pillai1, Shams I Iqbal, Raymond W Liu

  • 1Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA, anil.pillai@utsouthwestern.edu.

Cardiovascular and Interventional Radiology
|February 21, 2014
PubMed

Insights

Segmental arterial mediolysis (SAM) is a rare arteriopathy causing dissecting aneurysms and rupture. While often self-limiting, acute presentations carry a 50% mortality risk, requiring prompt intervention.

Area of Science:

  • Vascular Medicine
  • Pathology
  • Radiology

Background:

  • Segmental arterial mediolysis (SAM) is a rare, nonatherosclerotic arteriopathy affecting large to medium-sized arteries.
  • Histologically, it involves vacuolization and lysis of the outer media, leading to dissecting aneurysms and potential vessel rupture.
  • Clinical presentation ranges from self-limiting abdominal pain to life-threatening hemorrhage.

Purpose of the Study:

  • To review the characteristics, diagnosis, and management of Segmental arterial mediolysis.
  • To highlight key distinguishing features of SAM from other vasculopathies.
  • To discuss the acute and long-term prognosis of SAM.

Main Methods:

  • Literature review of Segmental arterial mediolysis cases.
  • Analysis of histological findings and imaging characteristics.
  • Review of clinical presentations, treatment strategies, and outcomes.

Main Results:

  • SAM affects all ages, with a predilection for the 5th and 6th decades and a slight male predominance.
  • Key imaging findings include segmental dissections of the celiac, mesenteric, and/or renal arteries.
  • Inflammatory markers and specific genetic/coagulable studies are typically negative, differentiating SAM from other vasculitides.

Conclusions:

  • Segmental arterial mediolysis is a distinct arteriopathy with specific diagnostic criteria.
  • Acute SAM with aneurysmal rupture has a high mortality rate (50%), necessitating urgent surgical or endovascular treatment.
  • Conservative management is appropriate for non-acute cases, with blood pressure control being the cornerstone of therapy.

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