Surgical and Endovascular Treatment of Segmental Arterial Mediolysis
Kate X. Peng1, Sailendra G. Naidu1, Thomas C. Bower2, Robert D. McBane2, Samuel R. Money1.
1Mayo Clinic Arizona, Phoenix, AZ, USA, 2Mayo Clinic, Rochester, MN, USA.
Objectives:
Segmental Arterial Mediolysis (SAM) is a rare non-atherosclerotic, non-inflammatory disease resulting from the degeneration of the arterial media. Patients can present with bleeding, aneurysm, dissection, or stenosis, usually of the visceral and renal vessels.
Methods:
Retrospective review of patients diagnosed with SAM at our institution was conducted to evaluate those who underwent open or endovascular interventions.
Results:
120 patients had diagnosis of SAM. 19 required intervention (12 male, 7 female). Mean age was 59.8 (42 to 84 years). Clinical presentation included 9 patients with abdominal or flank pain, 4 acute hemorrhage, 6 asymptomatic. Affected vessels included 12 in the celiac bundle, 4 superior mesenteric artery, 2 renal artery, and 1 inferior mesenteric artery. Indication for intervention included 7 aneurysms, 7 pseudoaneurysms, 3 dissections, 1 stenosis, and 1 hepato-portal fistula.
12 patients underwent endovascular treatment alone: 5 underwent coil embolization, 4 coil embolization with particles/glue, 1 glue embolization and 1 stenting. One endovascular patient underwent concomitant percutaneous embolization. 6 patients had surgical intervention alone: 3 aortic bypass grafting to affected vessels, 2 patch angioplasty with thrombectomy, and 1 aortic bypass grafting with patch angioplasty. One patient underwent both open and endovascular intervention with aortic bypass grafting and coil embolization.
Initial success was achieved in 18 of 19 patients. One patient expired secondary to ongoing hemorrhage from a bleeding pseudoaneurysm. Long-term follow-up was available on 18 patients, mean 29.8 months (1-144 months). 17 patients remained asymptomatic from the treated vessels. One had chronic multifactorial abdominal pain. One patient developed bypass graft thrombosis and was asymptomatic.
Conclusion:
SAM is an unusual vascular disease frequently involving the visceral and renal vessels. Successful treatment modalities include both open and endovascular options which yield excellent results. The appropriate management must be tailored to the anatomy and clinical condition of the patient.
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