Transcatheter Arterial Embolization for Segmental Arterial Mediolysis

Abstract

Purpose:

To report outcomes of transcatheter arterial embolization for segmental arterial mediolysis (SAM), a vascular disorder characterized by angiographically documented fusiform aneurysms separated by areas of normal appearing vessel in the celiac or mesenteric arteries.

Case Reports:

Four patients (3 men; median age 70 years, range 57–77) had a presumptive diagnosis of SAM; the possibility of vasculitis was ruled out based on clinical and laboratory findings. Three patients were symptomatic, with aneurysm rupture; the fourth patient was diagnosed incidentally. Coil embolization was used in 3 cases and N-butyl cyanoacrylate in the other. There was no re-rupture. One patient developed a focal dissection of the superior mesenteric artery 9 months after middle colic artery embolization. Another patient died of perforation of the lower gastrointestinal tract 3 months after treatment, but the cause was unknown; mesenteric ischemia from embolization and arteriopathy could not be ruled out.

Conclusion:

Transcatheter embolization is useful for SAM. However, it is likely that the morphology associated with SAM transforms rapidly, so patients undergoing mesenteric artery embolization should be monitored at short intervals.