Author + information
- Stanislav Henkina,b,
- Waldemar Wysokinskia,b,
- Yvonne Littlea,b,
- Fadi Shamouna,b,
- Eddie Greenea,b and
- Robert McBanea,b
Background: Segmental arterial mediolysis (SAM) is a rare non-inflammatory non-atherosclerotic disease characterized by lysis of the arterial media. The clinical presentation varies from acute self-limiting pain to organ infarction and death from arterial dissection. The natural history and risk of re-dissection however is not well defined.
Methods: Consecutive patients with SAM (1/1/2000 to 12/31/2015) seen at Mayo Clinic were evaluated for demographics, cardiovascular risk factors, imaging findings, and treatment to identify independent predictors of re-dissection.
Results: Of 108 patients with SAM, most were male (71%) with a low prevalence of cardiovascular risk factors (coronary artery disease, 4.6%; diabetes mellitus, 1.9%; hypertension, 29.6%; hyperlipidemia, 31.5%; active smoker, 21.3%). Average age at diagnosis was 51.5 years (±10.0 years). Twenty-five individuals (23.1%) received a concurrent diagnosis of fibromuscular dysplasia (FMD). Presenting symptoms included abdominal pain (70.4%), hypertension (26.0%), flank pain (24.1%), and nausea (22.2%); 8 individuals (7.4%) were asymptomatic. Renal (44.4%), superior mesenteric (38.9%), and celiac (38.0%) artery involvement was most common. At presentation, 45.4% had evidence of organ infarction (80% renal, 18.4% splenic). During a median follow up of 36.5 months (interquartile range [IQR] 15, 66.3), 16 (14.8%) experienced re-dissection at median of 17 months (IQR 0.25, 47.5), primarily of super mesenteric (43.8%) and renal (34.5%) arteries. Only a history of organ infarction was a risk factor of re-dissection (p=0.04). Medications including anticoagulants, anti-platelet agents, beta-blocker, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or statin agents was not protective of re-dissection.
Conclusions: Repeated dissection occurs infrequently (5% annually) in patients with SAM. Organ infarction at presentation was the only independent predictor of re-dissection in this population.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Vascular Medicine: Emerging Concepts in Clinical Vascular Diseases
Abstract Category: 40. Vascular Medicine: Non Coronary Arterial Disease
Presentation Number: 1254-353
- 2017 American College of Cardiology Foundation