Journal of vascular and interventional radiology : JVIR · 2026
Segmental Arterial Mediolysis: A Systematic Review of Clinical Presentations, Management, and Outcomes.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Kaur Harleen, Kathuria Manoj, Choudhary Moaz M, Sutphin Patrick, Beechar Arpita, Kishore Kamal, Kalva Sanjeeva P
Аннотация
PURPOSE: To consolidate evidence on the clinical profile of segmental arterial mediolysis (SAM) and to identify independent predictors of unfavorable outcomes and mortality.
MATERIALS AND METHODS: PubMed/MEDLINE was systematically searched for SAM reports with patient-level data. Data analysis used χ2 or Fisher exact, Mann-Whitney, and Kruskal-Wallis tests and multivariable logistic regression, with sensitivity analyses across 3 subgroups.
RESULTS: In total, 230 confirmed cases of SAM were included (mean age, 54.5 years; 65% men). Hypertension was the most common comorbidity (21.7%). Most patients (84%) presented acutely, typically with abdominal pain (49%) or hemorrhage (19.6%). Multifocal involvement frequently involved the superior mesenteric (40%), hepatic (40%), and celiac arteries (36.5%). Imaging was dominated by aneurysms (69%-100%) and dissections (0%-65%). Elevated erythrocyte sedimentation rate/C-reactive protein was associated with organ ischemia (odds ratio [OR], 3.36; 95% confidence interval [CI], 1.65-6.86; P = .002). Management was guided by clinical stability and lesion morphology, with medical therapy and transarterial embolization being the most common. Overall, 81.3% achieved favorable outcomes; 18.7% had progression or death. Overall mortality was 9.1%. Neurologic territory involvement (OR, 7.25; 95% CI, 2.61-20.14; P < .001) and organ ischemia on imaging (OR, 2.56; 95% CI, 1.07-6.10; P = .034) were independent predictors of unfavorable outcome. Neurologic involvement (OR, 5.73; 95% CI, 1.71-19.15; P = .005) and female sex (OR, 3.88; 95% CI, 1.38-10.88; P = .010) were independent predictors of mortality. Findings were robust on sensitivity analyses.
CONCLUSION: SAM typically presents with multifocal mesenteric or hepatic aneurysms or dissections and favorable outcomes with conservative or endovascular management. Neurologic involvement and organ ischemia predict worse outcomes, supporting risk-stratified management and surveillance.
MATERIALS AND METHODS: PubMed/MEDLINE was systematically searched for SAM reports with patient-level data. Data analysis used χ2 or Fisher exact, Mann-Whitney, and Kruskal-Wallis tests and multivariable logistic regression, with sensitivity analyses across 3 subgroups.
RESULTS: In total, 230 confirmed cases of SAM were included (mean age, 54.5 years; 65% men). Hypertension was the most common comorbidity (21.7%). Most patients (84%) presented acutely, typically with abdominal pain (49%) or hemorrhage (19.6%). Multifocal involvement frequently involved the superior mesenteric (40%), hepatic (40%), and celiac arteries (36.5%). Imaging was dominated by aneurysms (69%-100%) and dissections (0%-65%). Elevated erythrocyte sedimentation rate/C-reactive protein was associated with organ ischemia (odds ratio [OR], 3.36; 95% confidence interval [CI], 1.65-6.86; P = .002). Management was guided by clinical stability and lesion morphology, with medical therapy and transarterial embolization being the most common. Overall, 81.3% achieved favorable outcomes; 18.7% had progression or death. Overall mortality was 9.1%. Neurologic territory involvement (OR, 7.25; 95% CI, 2.61-20.14; P < .001) and organ ischemia on imaging (OR, 2.56; 95% CI, 1.07-6.10; P = .034) were independent predictors of unfavorable outcome. Neurologic involvement (OR, 5.73; 95% CI, 1.71-19.15; P = .005) and female sex (OR, 3.88; 95% CI, 1.38-10.88; P = .010) were independent predictors of mortality. Findings were robust on sensitivity analyses.
CONCLUSION: SAM typically presents with multifocal mesenteric or hepatic aneurysms or dissections and favorable outcomes with conservative or endovascular management. Neurologic involvement and organ ischemia predict worse outcomes, supporting risk-stratified management and surveillance.