Segmental Arterial Mediolysis: A Systematic Review of Clinical Presentations, Management, and Outcomes.
Harleen Kaur, Manoj Kathuria, Moaz M Choudhary et al.
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In 30 seconds
This systematic review consolidated patient-level reports of segmental arterial mediolysis (SAM) to describe presentation, management, and outcomes and identify predictors of poor prognosis. It included 230 confirmed cases; 84% presented acutely, most often with abdominal pain or hemorrhage, and imaging commonly showed aneurysms or dissections. Overall, 81.3% had favorable outcomes, while 18.7% experienced progression or death and mortality was 9.1%. Neurologic involvement and imaging evidence of organ ischemia independently predicted unfavorable outcomes; neurologic involvement and female sex independently predicted mortality.
Key findings
- Among 230 cases, 84% presented acutely, commonly with abdominal pain (49%) or hemorrhage (19.6%).
- Aneurysms were reported in 69%-100% and dissections in 0%-65%; multifocal disease often involved superior mesenteric, hepatic, or celiac arteries.
- Favorable outcomes occurred in 81.3%; 18.7% had progression or death, and overall mortality was 9.1%.
- Neurologic involvement predicted unfavorable outcome (OR, 7.25; 95% CI, 2.61-20.14) and mortality (OR, 5.73; 95% CI, 1.71-19.15).
Why it matters
SAM can present acutely with visceral arterial aneurysms or dissections, and the review indicates that outcomes are not uniformly benign. Recognition of neurologic involvement and organ ischemia as markers of worse outcomes may help clinicians assess risk and interpret the need for closer monitoring, while the reported range of presentations underscores the value of considering disease distribution and lesion morphology.
What to keep in mind
The review relied on published reports with patient-level data, so its findings may reflect reporting and selection biases; the abstract does not describe prospective validation of the predictors.