Abstract
Aim Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic, non-inflammatory,
non-infectious arteriopathy in middle-aged patients that tends to affect medium-sized
splanchnic arteries typically leading to dissecting aneurysms which in case of rupture
have a high mortality. Treatment options include watchful waiting and endovascular
or surgical intervention. There are no official treatment guidelines and to the best
of our knowledge, there has not been any report of extensive exclusion of multiple
splanchnic vessel regions in affected patients to date.
Materials and Methods We retrospectively examined the outcome of extensive splanchnic embolization in four
patients suffering from SAM between 2011 and 2016 with follow-up periods of up to
7 years.
Results One patient presented with abdominal pain due to rupture of aneurysms of the pancreaticoduodenal
arcade, one with abdominal pain due to dissection, and two were clinically asymptomatic
but displayed rapidly progressing disease over the course of 12 months. All patients
were treated with complete exclusion of the diseased vessel segments by coiling all
branches to and from the diseased segment. In three cases the main hepatic artery
was excluded completely. In one case, the complete vascular bed of the celiac axis
was excluded by coiling the distal vessel branches and placing a stent graft over
the orifice of the celiac trunk. During a follow-up period of a minimum of 2 and a
maximum of 7 years after intervention, there were no immediate or long-term complications
except for a temporary arterio-portal fistula. Interestingly, no new diseased areas
of SAM were detected afterwards.
Conclusion Extensive endovascular exclusion of the entire diseased arterial segment with coils
seems to be a safe and effective treatment option in patients with SAM presenting
with ruptured or rapidly growing aneurysms. Provided that patients have normal liver
function and proper portal venous flow, risk of hepatobiliary complications seems
to be low even after extensive embolization.
Key points:
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An asymptomatic SAM can be followed up.
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In case of disease progression or suspicion of aneurysm rupture, an endovascular approach
is indicated where the whole pathological vessel bed should be excluded with coils.
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It seems that exclusion of even extensive vessel areas is tolerated.
Citation Format
Key words
embolization - segmental arterial mediolysis - visceral artery aneurysm
