Median Arcuate Ligament Syndrome Is Not a Vascular Disease

Weber, J; Boules, Mena; Fong, Kathryn; Abraham, Benjamin; Bena, James; El‐Hayek, Kevin; Kroh, Matthew; Park, Woosup Michael

doi:10.1016/j.avsg.2015.07.013

Cited by 71 publications

(62 citation statements)

References 13 publications

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“…1,6,7 Alternatively, there are also hypotheses about neurogenic mechanisms. 7,8 Left untreated, individuals with MALS may suffer complications such as gastroparesis and arterial aneurysms. 9,10 Visceral thromboembolic events are rare sequelae, and interestingly, splenic infarcts as a result of MALS, as seen in this case, have not been previously described in the literature.…”

Section: Discussionmentioning

confidence: 99%

Intravascular ultrasound-guided laparoscopic division of the median arcuate ligament

Bayat

Wang

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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Median arcuate ligament syndrome is a rare and poorly understood condition that can have a significant impact on the quality of life of patients. Diagnosis is often difficult and delayed because of the need to exclude other pathologic processes. Treatment strategies traditionally involve open or laparoscopic division of the median arcuate ligament, with or without vascular reconstruction. This report portrays a case of median arcuate ligament syndrome with compression of two visceral arteries and distal embolic complications. A novel hybrid technique is described using intravascular ultrasound technology to aid in laparoscopic median arcuate ligament division. This allowed real-time intravascular visualization of the compressive segment, guided release of the ligament fibers, and demonstrated confirmation of decompression. (J Vasc Surg Cases and Innovative Techniques 2020;6:147-51.)

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Section: Discussionmentioning

confidence: 99%

Intravascular ultrasound-guided laparoscopic division of the median arcuate ligament

Bayat

Wang

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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show abstract

“…The advantages of this approach are clear and include decreased postoperative pain, shorter hospital stay and faster recovery, and decreased postoperative adhesions. In 2016, Weber et al conducted a large study enrolling 39 patients treated with laparoscopic MAL release, reporting good results in the follow-up (84.6% symptom relief and 10.3% conversion to open surgery due to intraoperative hemorrhage) [19]. An interesting point of this study of Weber et al is that 6 out of 26 patients during follow-up showed persistent stenosis and 1 occlusion, but were symptom free.…”

Section: Discussionmentioning

confidence: 89%

“…Most recent studies suggest that the laparoscopic approach is best [19, 20]. We believe that an open approach is needed when a structural defect of the vessel is detected or even suspected.…”

Section: Discussionmentioning

confidence: 99%

Open vascular treatment of median arcuate ligament syndrome

et al. 2017

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BackgroundMedian arcuate ligament syndrome is a rare condition with abdominal symptoms. Accepted treatment options are open release of median arcuate ligament, laparoscopic release of edian arcuate ligament, robot-assisted release of median arcuate ligament and open vascular treatment. Here we aimed to evaluate the central priority of open vascular therapy in the treatment of median arcuate ligament syndrome.MethodsWe conducted a monocentric retrospective study between January 1996 and June 2016. Thirty-one patients with median arcuate ligament syndrome underwent open vascular surgery, including division of median arcuate ligament in 17 cases, and vascular reconstruction of the celiac artery in 14 cases.ResultsIn a 20-year period, 31 patients (n = 26 women, n = 5 men) were treated with division of median arcuate ligament (n = 17) or vascular reconstruction in combination with division of median arcuate ligament (n = 14). The mean age of patients was 44.8 ± 15.13 years. The complication rate was 16.1% (n = 5). Revisions were performed in 4 cases. The 30-day mortality rate was 0%. The mean in-hospital stay was 10.7 days. Follow-up data were obtained for 30 patients. The mean follow-up period was 52.2 months (range 2–149 months). Patients were grouped into a decompression group (n = 17) and revascularisation group (n = 13). The estimated Freedom From Symptoms rates were 93.3, 77.8, and 69.1% for the decompression group and 100, 83.3, and 83.3% for the revascularisation group after 12, 24 and 60 months respectively. We found no significant difference in the Freedom From Re-Intervention CA rates of the decompression (100% at 12, 24 and 60 months post-surgery) and revascularisation (100% at 12 months, and 91.7% at 24 and 60 months post-surgery) groups during follow-up (p = 0.26).ConclusionsOpen vascular treatment of median arcuate ligament syndrome is a safe, low mortality-risk procedure, with low morbidity rate. Treatment choice depends on the clinical and morphological situation of each patient.

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“…Conversely, our review shows that although there was a very low utilization of concomitant vascular procedures (4.8% of cases and 0% in the LMALr and RMALr groups, respectively), the immediate symptomatic improvement rate was very high, with a low percentage of recurrence. Six authors reported adjunctive intraoperative vascular procedures in the LMALr group . The great majority were celiac percutaneous transluminal angioplasty (PTA) of the celiac axis with or without stent insertion (13 cases, 76.5%).…”

Section: Discussionmentioning

confidence: 99%

“…Some authors hypothesized that the pain associated with MALS has a neuropathic component, resulting from a combination of chronic compression and overstimulation of the celiac ganglion by the fibers of the MAL. The compression of the celiac plexus could result in altered sensation and abdominal pain from the somatic nerves, and therefore celiac ganglionectomy associated with ligament release could provide pain relief …”

Section: Discussionmentioning

confidence: 99%