Diagnosis and management of fibromuscular dysplasia and segmental arterial mediolysis in gastroenterology field: A mini-review

Table 2 Summary of mesenteric segmental arterial mediolysis reported to date

Case (n)	Ref.	Age (yr)	Gender (Male/Female)	Risk factors	Symptoms	Vessels Involved	CT	Angiography	Pathology	Treatment	Anti-hypertensive drug	Anti-coagulants	Outcome
1	[48]	65	F	N/A	Abdominal pain	SMA	N/A	Beaded appearance and stenosis of the MCA	Lysis and destruction in the media and intima	Resection of aneurysm in MCA	N/A	N/A	Improved
2	[49]	56	F	N/A	Abdominal pain	IMA	Intraabdominal hemorrhage	Aneurysm in IMA	N/A	Left hemicolectomy	N/A	N/A	Improved
3	[50]	78	M	N/A	Abdominal pain, diarrhea, shock	SMA	N/A	N/A	Destruction of the tunica interna and media in MCA	Emergent surgery (right hemicolectomy); a large hematoma and a ruptured aneurysm upon the surgery	N/A	N/A	Improved
4	[51]	35	F	N/A	Abdominal pain, perforation on transverse colon	SMA	Occlusion of the mesenteric vein and ischemic colitis	Unremarkable	Segmental vacuolar degeneration of smooth muscle with areas of wall thinning	Resection of terminal ileum	N/A	N/A	Died
5	[52]	52	M	N/A	Sudden hemiparesis, hypertension	Celiac, SMA, IMA hepatic artery	Aneurysm in the celiac, hepatic, SMA	Aneurysms in celiac, SMA, ICA, hepatic; stenoses in celiac and SMA	Multiple segmental mediolysis lesions of the muscular and elastic fibers of the media	Reconstruction of hepatic and celiac artery using autologous saphenous vein graft	N/A	N/A	Improved
6	[53]	49	M	N/A	Abdominal pain, shock	SMA	Large hematoma surrounding a high-density aneurysm	Beaded appearance in SMA	Multifocal fragmentation of the elastic fibers of the media	Right hemicolectomy	N/A	N/A	Improved
7	[54]	57	M	N/A	Abdominal pain	SMA, hepatic	Small aneurysm at the middle colic artery and mesenteric hematoma	Aneurysm and stenosis of the celiac, SMA, hepatic artery	N/A	Embolization with N-butyl cyanoacrylate for aneurysm in the SMA	N/A	N/A	Improved
8	[54]	76	F	N/A	Abdominal pain, nausea	IMA	Mesenteric hematoma	Aneurysm in IMA	N/A	Embolization with coil	N/A	N/A	Died
9	[55]	59	M	N/A	Abdominal pain, shock	SMA, RA, gastroepiploic, splenic	SMA dissection, aneurysm in RA, gastroepiploic, splenic artery; rupture of the splenic aneurysm	Saccular aneurysms and multiple stenotic region in gastroepiploic artery	Medial island spared from mediolysis	Emergency embolization of the splenic artery, resection of aneurysm in the gastroepiploic	N/A	N/A	Improved
10	[56]	57	M	N/A	Abdominal pain, diarrhea	SMA	Ascites throughout the abdomen	Aneurysm in SMA	N/A	Transcatheter arterial embolization	N/A	N/A	Improved
11	[57]	60	M	N/A	N/A	SMA	Rupture of the aneurysm of the MCA	Multiple beaded patters and aneurysm in SMA	N/A	Surgical resection	N/A	N/A	Improved
12	[47]	25	F	N/A	Anorexia, abdominal pain, diarrhea	SMA, hepatic	Ischemic colitis of the splenic flexure	Occlusion of IMA; stenoses of the hepatic artery	Patchy, isolated destruction of the arterial media involving both the internal and external elastic laminae	Partial colectomy of the splenic flexure	N/A	N/A	Improved
13	[58]	53	M	N/A	None	Celiac, SMA, splenic	Aneurysm in splenic, celiac, SMA; dissection in the celiac.	Aneurysm in the celiac, splenic, and SMA	N/A	Embolization with coil and aortic stent graft	N/A	N/A	Improved
14	[59]	51	M	N/A	Abdominal pain, shock	SMA, IMA	Abdominal hemorrhage	Active bleeding from SMA	N/A	Embolization and ligation of the branches of the SMA	N/A	Warfarin	Improved
15	[60]	29	F	N/A	Hypertension	SMA, RA, hepatic	Renal cortical nephrograms	Scattered microaneurysms in SMA, RA, hepatic artery	Segmental lesions of the media with loss of smooth muscle cells	Anti-coagulants	N/A	Warfarin	Improved
16	[61]	55	F	N/A	Abdominal pain	Celiac, SMA, hepatic, splenic	Unremarkable in vessels	Aneurysms in celiac, SMA, hepatic, splenic artery	N/A	Anti-coagulants	N/A	Warfarin followed by aspirin	Improved
17	[62]	56	M	N/A	Abdominal pain, shock	SMA	Aneurysm in MCA, SMA dissection	Saccular aneurysms in the MCA; dissections in the SMA	N/A	Embolization with coil	N/A	N/A	Improved
18	[63]	64	F	N/A	Abdominal pain, back pain, nausea	SMA, IMA, hepatic	Hematoma in the anterior pararenal space inferior to pancreatic tail; bleeding from aneurysm	Multiple aneurysms in the SMA, IMA, hepatic artery	N/A	Conservative	N/A	N/A	Improved
19	[64]	60	F	Hypoxia	Hypoxia, hypotension, cardiopulmonary arrest	SMA	Large hematoma in the retroperitoneal and intraperitoneal space; SMA aneurysm	Aneurysms and beaded appearance in the SMA	N/A	Conservative	N/A	N/A	Improved
20	[65]	36	M	N/A	Abdominal pain	Celiac, hepatic, anterior inferior pancreaticoduodenal artery	Stenosis and aneurysms in anterior inferior pancreatic duodenal artery	Aneurysms and beaded like appearance in the anterior inferior pancreaticoduodenal artery	N/A	Embolization with coil	N/A	N/A	Improved
21	[66]	47	M	N/A	Loss of consciousness, headache, abdominal pain	SMA	SAH, massive intraperitoneal hematoma	Beaded like appearance in SMA; dissection in VA	Medial islands and medial degenerations in SMA	Embolization with coil for VA and SMA. Surgical resection of part of middle colic artery and descending colon.	N/A	N/A	Improved
22	[67]	79	M	N/A	Abdominal pain, hypotension	IMA	Active bleeding from IMA and hemorrhage	N/A	Reduplication of the internal elastic lamina with arterial dissection within the tunica media and thrombus at the site of rupture	Surgical resection of left colic artery	N/A	N/A	Improved
23	[68]	40	M	N/A	Abdominal pain	Celiac, SMA	Extensive dissection of SMA with the thrombotic occlusion. stenosis and dilation of celiac artery	N/A	N/A	Conservative	N/A	N/A	Improved
24	[69]	32	M	N/A	Abdominal pain	IMA, RA	Aneurysm in renal and IMA, massive amount of hemorrhage	Stenosis and aneurysm in the RA	Media shows myxoid degeneration in the outer one-third adjacent to the adventitia	Surgical hemostasis and left hemicolectomy	Yes, N/A	N/A	Improved
25	[70]	58	M	N/A	Abdominal pain	SMA	Mesenteric hematoma and right inguinal hernia with unremarkable small bowel	Beaded like appearance in SMA	N/A	Immunosuppressive therapy	N/A	N/A	Improved
26	[71]	57	M	N/A	Hypertension, abdominal pain	SMA	Arterial dissection with luminal stenosis and aneurysm formation at the distal portion of the SMA	Segmental dilatation, aneurysm in the SMA	Vacuolization and decrease in the number of vascular smooth muscles	Aneurysmectomy and bowel resection	Ca-blocker	N/A	Improved

M: Male; F: Female; N/A: Data not applicable; SMA: Superior mesenteric artery; IMA: Inferior mesenteric artery; RA: Renal artery; CT: Computed tomography; MCA: Middle cerebral artery.