Epidemiology

History

• Segmental Arterial Mediolysis was First Described in 1976 (Lab Invest, 1976) [MEDLINE]

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Etiology

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Physiology

Vasospastic Arteriopathy Involving the Muscular Arteries Innervated by the Peripheral Sympathetic Nervous System

• Initiated by the Coupling of Norepinephrine to Plastically Derived Hyperdense Foci of α-Adrenergic Receptors on the Sarcolemma of Arterial Muscle (Int J Vasc Med, 2021) [MEDLINE]
• Segmental Arterial Mediolysis Generally Occurs in the Medium/Large Muscular Arteries Located in the Abdomen, Retroperitoneum, Heart, and Brain Base
  • Although Segmental Arterial Mediolysis is Generally is Restricted to One of these Anatomic Sites, Simultaneous Occurrence of Segmental Arterial Mediolysis in >1 Site Have Been Reported Most Frequently in Intestinal and Retroperitoneal Arteries (Cardiovascular Pathol, 2009) [MEDLINE]

Mechanisms Involved in the Pathogenesis of Segmental Arterial Mediolysis

• Hypoxia
• Shock
• Aging
• Hypertension
• Circulatory Disturbance
• Arteriospasm and Other Vasoconstrictor Stimuli

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Diagnosis

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Clinical Manifestations

Gastrointestinal Manifestations

Intraperitoneal Hemorrhage

• Epidemiology
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• Clinical
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Retroperitoneal Hemorrhage

• Epidemiology
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• Clinical
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Neurologic Manifestations

Basilar Subarachnoid Hemorrhage (SAH) (see Subarachnoid Hemorrhage)

• Epidemiology
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Other Manifestations

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Treatment

Catheter-Based Endovascular Techniques

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Surgery

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References

General

• Segmental mediolytic arteritis: a clinical pathologic study. Lab Invest 1976; 35: 23-29 [MEDLINE]
• Segmental arterial mediolysis: course, sequelae, prognosis, and pathologic-radiologic correlation. Cardiovasc Pathol. 2009 Nov-Dec;18(6):352-60. doi: 10.1016/j.carpath.2008.09.001 [MEDLINE]
• Segmental arterial mediolysis. Cardiovasc Intervent Radiol. 2014 Jun;37(3):604-12. doi: 10.1007/s00270-014-0859-4 [MEDLINE]
• Segmental arterial mediolysis: a systematic review of 85 cases. Ann Vasc Surg. 2014 Jan;28(1):269-77. doi: 10.1016/j.avsg.2013.03.003 [MEDLINE]
• Imaging and clinical findings in segmental arterial mediolysis (SAM). Abdom Radiol (NY). 2017 Feb;42(2):602-611. doi: 10.1007/s00261-016-0887-4 [MEDLINE]
• The Intriguing Occurrence of Segmental Arterial Mediolysis: Case Report and Concise Literature Review. Cardiovasc Hematol Disord Drug Targets. 2017;17(2):74-79. doi: 10.2174/1871529X17666170703115833 [MEDLINE]
• Diagnosis and management of fibromuscular dysplasia and segmental arterial mediolysis in gastroenterology field: A mini-review. World J Gastroenterol. 2018 Aug 28;24(32):3637-3649. doi: 10.3748/wjg.v24.i32.3637 [MEDLINE]
• Segmental Arterial Mediolysis: A Multiguised Vasospastic Arteriopathy with Collateral Mesangial Cell Hyperplasia and Cardiac Toxicity Generated by Norepinephrine and Hyperdense Adrenoceptors Alone or by Crosstalk with Other Pressor Agents. Int J Vasc Med . 2021 Nov 23;2021:2046566. doi: 10.1155/2021/2046566. eCollection 2021 [MEDLINE]