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(A) Pathogenesis of segmental arterial mediolysis (SAM). Vacuolization and lysis of the outer arterial media leads to formation of arterial gaps and patchy transmural loss of the external elastic lamina. (B) Pathogenesis of SAM. Dissecting hematomas (asterisk “*”) and aneurysms occur at the arterial gaps with separation of the media from the adventitia.
