Factors Associated with Symptomology of Celiac Artery Compression and Outcomes following Median Arcuate Ligament Release

Khrucharoen, Usah; Juo, Yen-Yi; Sanaiha, Yas; Finn, J. Paul; Jiménez, Juan Carlos; Dutson, Erik

doi:10.1016/j.avsg.2019.06.025

Cited by 21 publications

(12 citation statements)

References 25 publications

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“…Other options also include endovascular stenting, bypass grafting, or percutaneous transluminal angioplasty. Surgical release and vascular intervention combined typically yield the best results, and patients should be counseled on the potential need for multiple interventions to maintain an asymptomatic prognosis [6,7,9,10]. In our patient, the surgical release was not enough for symptom resolution, and the patient eventually ended up requiring endovascular stenting for persistent symptoms.…”

Section: Discussionmentioning

confidence: 94%

“…The pathophysiology of this condition remains to be elucidated. The cause is most likely multifactorial, combining the effects of celiac artery compression and subsequent foregut ischemia, with celiac plexus and/or celiac ganglion irritation and subsequent splanchnic vasoconstriction to cause the presenting symptoms [ 1 , 6 , 7 , 9 , 10 ]. This multifactorial etiology appears to be supported by a study demonstrating that correction of celiac artery compression alone results in 53% of patients being asymptomatic on long-term follow-up, whereas combined release and revascularization results in 79% of patients being asymptomatic on long-term follow-up [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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An Unusual Presentation of Median Arcuate Ligament Syndrome

Mehta

Bath

Ahmed

et al. 2020

Cureus

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Median arcuate ligament syndrome (MALS) is a rare benign condition typically affecting young females. It usually presents with abdominal symptoms of pain, nausea, and unintentional weight loss. They are usually diagnosed incidentally on CT of the abdomen done for abdominal pain. Here we present a rare case of MALS which presented with an anginal type of chest pain without any abdominal symptoms leading to an extensive workup and incidental diagnosis.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

An Unusual Presentation of Median Arcuate Ligament Syndrome

Mehta

Bath

Ahmed

et al. 2020

Cureus

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“…However, it is four times more likely to occur in women than men and is most common in patients between 30 and 50 years of age with a thin body habitus [ 9 ]. Symptoms have been found to occur more frequently in patients with more pronounced celiac artery compression on imaging and those with prior abdominal surgery [ 10 ]. On physical examination, patients may have abdominal bruits (85%), but up to 30% of patients without this condition may also have this finding [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Median Arcuate Ligament Syndrome Masquerading as Functional Abdominal Pain Syndrome

Scharf¹,

Thomas²,

Sundaram³

et al. 2021

Cureus

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Median arcuate ligament syndrome refers to anatomical compression of the celiac artery and/or ganglion by fibrous attachments of the median arcuate ligament. It typically presents as a vague constellation of abdominal symptoms that are often initially attributed to various other gastrointestinal pathologies; thus, it can be very difficult to diagnose. We present a case of median arcuate ligament syndrome in a 68-year-old woman, whose diagnosis and treatment were delayed by many years as her symptoms were taught to be the result of functional abdominal pain syndrome, ultimately corrected by laparoscopic decompression of the celiac axis. This case demonstrates that surgical decompression of the celiac axis is an effective treatment for median arcuate ligament syndrome and the importance of continuing to reassess the clinical picture of patients labeled with functional abdominal pain syndrome.

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“…To achieve this, both pre-and postoperative adjunctive therapies, along with the use of arterial reconstruction and stenting were used more often in these studies. [23][24][25][26][27][28][29] Therefore, the current literature makes accurate comparison of outcomes between pure treatment modalities difficult. The data also showed an increased conversion rate to open in laparoscopic studies compared to the data presented here.…”

Section: Literature Review and Summarymentioning

confidence: 99%

“…The data also showed an increased conversion rate to open in laparoscopic studies compared to the data presented here. [23][24][25][27][28][29]…”

Section: Literature Review and Summarymentioning

confidence: 99%

Robotic Surgery for Median Arcuate Ligament Syndrome

Fernstrum

Pryor

Wright

et al. 2020

JSLS

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Background: Compression of the celiac artery by the median arcuate ligament results in median arcuate ligament syndrome (MALS). Using a consecutive cohort of patients with MALS, this study evaluated the efficacy and safety of robotic median arcuate ligament release (MALR). Methods: A retrospective chart review was performed on patients who underwent robotic MALR from August 2012 to April 2018. Patient workup included history and physical examination, mesenteric Doppler ultrasound, and CT (Computed Tomography) scan. Outcomes included pain improvement, length of stay, operation duration, narcotic use, and postoperative complications. Results: Twenty-seven patients met inclusion criteria. Two thirds of the cohort were female and the mean age was 49 Ϯ 15.5 years. Postprandial abdominal pain was the most common preoperative symptom (25/27, 93%). CT (Computed Tomography) was performed in 24 (89%), and celiac stenosis Ͼ 70% was observed in all. Operative duration was 95 minutes on average (range, 53-358 minutes), and in 24/27 (89%) patients, estimated blood loss was Ͻ 100 mL. Eighty-one percent of patients were discharged the day of surgery (22/27). Two cases were converted to open, with only one major complication occurring. At 30 or more days postoperation, 17 patients (68%) had full, 1 (4%) partial, and 1 (4%) no symptom resolution, 6 (24%) had symptom recurrence after initially having resolution. Fifty-six percent achieved narcotic liberation 9/16 (56%). Conclusions: Robotic MALR is a safe option for treatment of MALS with high response rates, early hospital discharge, and opportunity for narcotic liberation.

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Factors Associated with Symptomology of Celiac Artery Compression and Outcomes following Median Arcuate Ligament Release

Cited by 21 publications

References 25 publications

An Unusual Presentation of Median Arcuate Ligament Syndrome

An Unusual Presentation of Median Arcuate Ligament Syndrome

Median Arcuate Ligament Syndrome Masquerading as Functional Abdominal Pain Syndrome

Robotic Surgery for Median Arcuate Ligament Syndrome

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