Successful treatment tailored to each splanchnic arterial lesion due to segmental arterial mediolysis (SAM): Report of a case Takuya Hashimoto, MD, Juno.

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Successful treatment tailored to each splanchnic arterial lesion due to segmental arterial mediolysis (SAM): Report of a case Takuya Hashimoto, MD, Juno Deguchi, MD, Hisako Endo, MD, Tetsuro Miyata, MD Journal of Vascular Surgery Volume 48, Issue 5, Pages 1338-1341 (November 2008) DOI: 10.1016/j.jvs.2008.05.056 Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 1 A, CT of the abdomen shows a large fluid collection in the left anterior pararenal space. Note the beaded aneurysms of the splenic artery (arrow). B, Selective angiography of the gastroepiploic artery. Saccular aneurysms and multiple stenotic regions are seen. There are also residual splenic artery aneurysms (arrow) at the distal site of coil embolization (white arrow). Journal of Vascular Surgery 2008 48, 1338-1341DOI: (10.1016/j.jvs.2008.05.056) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 2 A, B, Angiography of renal arteries. The bilateral renal arteries show aneurysmal change. C, 3-D CT of the head and neck. A small aneurysm (3 mm in diameter) is demonstrated in the distal site of the right internal carotid artery (arrow). D, Aneurysmal lesion of gastroepiploic artery. Arrow indicates a medial island spared from mediolysis. Other muscle fibers are lysed and replaced by fibrous granulation tissue. The internal elastic lamina is almost lost except for a medial island (Elastica van Gieson stain; magnification ×20). E, Vessel wall without aneurysmal change. Segmental areas of the outer media show ‘lytic spaces’ in which smooth muscle cells appear to have been lysed, showing an irregular border and replacement by fibrous granulation tissue (arrow) (Elastica van Gieson stain; magnification ×10). Journal of Vascular Surgery 2008 48, 1338-1341DOI: (10.1016/j.jvs.2008.05.056) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 3 Time course of vascular events. Aneurysms of the bilateral renal arteries were already noted at the time of rupture of splenic artery aneurysms. Gastroepiploic artery aneurysms and carotid artery aneurysm were detected 3 weeks and 1 month later, respectively. One and a half years elapsed from the initial event to the onset of SMA dissection. Journal of Vascular Surgery 2008 48, 1338-1341DOI: (10.1016/j.jvs.2008.05.056) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions