Celiac axis stenosis and digestive disease: Diagnosis, consequences and management

Dembinski, J.; Robert, B.; Sevestre, M.-A.; Freyermuth, Marc; Yzet, T.; Dokmak, S.; Régimbeau, Jean‐Marc

doi:10.1016/j.jviscsurg.2020.10.005

Cited by 5 publications

(5 citation statements)

References 83 publications

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“…It is prudent for the sonographer to confirm that the cause of this type of stenosis is intrinsic or extrinsic. 4 Sonography is especially useful in determining the patency of a vessel which can be difficult to fully identify on a CT examination.…”

Section: Discussionmentioning

confidence: 99%

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The Sonographer’s Role in Assessing Celiac Artery Stenosis, to Confirm the Diagnosis: A Case Study

Novitsky

2023

Journal of Diagnostic Medical Sonography

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Celiac artery stenosis may occur in patients with a known history of atherosclerosis and should also be considered in those who present with abdominal pain. Sonography is specific and necessary when the information is correlated with a computed tomogram (CT), as it helps to determine patency and velocity within mesenteric vessels. When stenosis is severe, chronic mesenteric ischemia results, as vascular perfusion is diminished to the intestinal organs. In the case presented with severe atherosclerosis, both CT and sonography were helpful in confirming the diagnosis. Sonography can help in evaluating celiac artery stenosis, caused by atherosclerosis versus median arcuate ligament syndrome, by considering the normal velocities of the vessel.

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Section: Discussionmentioning

confidence: 99%

“…3 It is of clinical importance to identify if the cause for CA stenosis is intrinsic or extrinsic, as the management of this disease can change depending on the exact etiology. 4…”

mentioning

confidence: 99%

The Sonographer’s Role in Assessing Celiac Artery Stenosis, to Confirm the Diagnosis: A Case Study

Novitsky

2023

Journal of Diagnostic Medical Sonography

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“…There are studies advocating that MAL release is a safe and sometimes necessary procedure to maintain adequate blood supply to liver graft. 4 , 6 , 8 On the contrary, some authors suggest that this technique has depicted poor outcomes and important postoperative complications, such as bleeding, pancreatitis, pancreatic fistula, gastroparesis, and pneumothorax. 2 , 9 , 10 A more conservative treatment has also been proposed, with preservation of the GDA during dissection, thus maintaining the blood flow from the superior mesenteric artery.…”

Section: Discussionmentioning

confidence: 99%

“…Otherwise, many surgical techniques have been proposed to restore blood flow during OLT. There are studies advocating that MAL release is a safe and sometimes necessary procedure to maintain adequate blood supply to liver graft 4,6,8 . On the contrary, some authors suggest that this technique has depicted poor outcomes and important postoperative complications, such as bleeding, pancreatitis, pancreatic fistula, gastroparesis, and pneumothorax 2,9,10 .…”

Section: Discussionmentioning

confidence: 99%

Impact of the presence of median arcuate ligament on biliary complications after liver transplantation

Gialamas

Assalino

Elkrief

et al. 2022

Clinical Transplantation

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Introduction The presence of median arcuate ligament (MAL) during orthotopic liver transplantation (OLT) may cause a significant reduction in the arterial hepatic flow. The aim of the present study is to investigate the impact of MAL on biliary complications in patients who underwent OLT. Methods We performed a retrospective case‐control study among patients who underwent OLT in Geneva University Hospital between 2007 and 2017, depending on the presence or absence of MAL. The matching was performed according to age, gender, lab‐MELD score at the time of OLT and type of donor (living or dead). The presence of MAL was assessed by an expert liver radiologist on the preoperative CT angiographic evaluation. Results The incidence of MAL was 6.1% (19 patients). Baseline characteristics were comparable between the two groups. No significant difference in biliary complications was found between patients with and without MAL (37% and 24%, respectively). No patient presented hepatic artery thrombosis. After logistic regression, in patients with MAL, the MAL release and gastroduodenal artery preservation compared to no treatment, showed an odds ratio for post‐OLT biliary complications of 1.5 and 1.25, respectively. There was no difference in overall graft survival and in hazard for biliary complications between patients with and without MAL. Conclusion In the present study, we did not find any difference in the prevalence of biliary and arterial complications between patients with and without MAL. The choice of MAL treatment did not influence in a significant way the overall outcome and development of complications. However, if, at the end of arterial reconstruction, the arterial flow is not adequately established, MAL needs to be treated with the least invasive technique.

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“…[ 1 ] The reported prevalence of CAS is ranging from 5 to 10%. [ 2 ] Many CAS cases are asymptomatic and therefore CAS often is an incidental finding in cross sectional imaging (i.e. CT and MRI) for preoperative assessment.…”

Section: Introductionmentioning

confidence: 99%

Clinical impact of a celiac axis stenosis in patients undergoing hepatobiliary surgery

Bieniek

Katou

Kraehling

et al. 2023

Langenbecks Arch Surg

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Background Celiac axis stenosis (CAS) often is an incidental finding in terms of diagnostic for hepatobiliary surgery since most cases remain asymptomatic. It remains unclear whether CAS is a risk factor for postoperative complications after hepatobiliary surgery. Therefore, the aim of this study was to evaluate the impact of an asymptomatic CAS on the postoperative morbidity and survival of patients undergoing hepatobiliary surgery. Methods We retrospectively analyzed CT scans and clinicopathological data of 250 consecutive patients undergoing hepatobiliary surgery between 2011 and 2018 in our tertiary center. We compared the postoperative course between patients with and without an incidental CAS as well as their overall survival. Results CAS was caused by atherosclerotic stenosis in 16 (64%) patients, by ligamentous stenosis in 4 (16%) and by combined conditions in 5 cases (20%). Mean age of patients in the CAS group was significantly higher in comparison to patients of the non-CAS group (71.0 vs. 59.1 years, p < 0.001). Major hepatectomy was conducted in 40% of the CAS patients and 19.6% of non-CAS patients, respectively (p = 0.036). Interestingly, no statistically significant differences in postoperative morbidity (40 vs. 46.2%, p = 0.673) or in overall survival between the groups (41.3 vs. 51.9 months, p = 0.611) were observed. Conclusion Our analysis found no correlation between an asymptomatic celiac axis stenosis and postoperative complications or overall survival after hepatobiliary surgery. Which impact the incidental CAS may have in highly complex cases remains unclear. Further studies are needed to identify patients who benefit from CAS treatment before hepatobiliary surgery.

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Celiac axis stenosis and digestive disease: Diagnosis, consequences and management

Cited by 5 publications

References 83 publications

The Sonographer’s Role in Assessing Celiac Artery Stenosis, to Confirm the Diagnosis: A Case Study

The Sonographer’s Role in Assessing Celiac Artery Stenosis, to Confirm the Diagnosis: A Case Study

Impact of the presence of median arcuate ligament on biliary complications after liver transplantation

Clinical impact of a celiac axis stenosis in patients undergoing hepatobiliary surgery

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