Transcatheter Arterial Embolization for Segmental Arterial Mediolysis

Abstract

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. 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. 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.