Median arcuate ligament syndrome with multivessel involvement: diagnosis with spiral CT angiography

Kopecky, Kenyon K.; Stine, S. B.; Dalsing, Michael C.; Gottlieb, Klaus

doi:10.1007/s002619900199

Cited by 62 publications

(50 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Since the first report by D'Abreu, several cases of RAE have been reported in the literature [3,10,17,19,20]. Similarly as observed in the presented cases, RAE usually develops in a RA with its origin high on the aorta.…”

Section: Discussionsupporting

confidence: 77%

“…Since this first description, reports of renal artery entrapment (RAE) by the diaphragm have been reported infrequently in the literature and high RA origin is commonly known as a predictor of RAE [3,10,17,19,20]. Entrapment syndromes also include entrapment of coeliac trunk (median arcuate ligament syndrome), superior mesenteric artery, aorta, renal vein.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Renal artery entrapment — anatomical risk factors rating

et al. 2016

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Renal artery entrapment — anatomical risk factors rating

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Helicoidal angioscanner imaging is particularly useful when examining the relation between the diaphragm and arterial structures. In 1995, the first diagnosis of renal artery stenosis was made by this method by Kopecky et al 3 In the case presented here, renal angioplasty with stenting led to an initial fall in blood pressure, but this was complicated by a subsequent fracture of the stent that led to a surgical solution. The only reported case of angioplasty without stenting was technically unsuccessful and needed surgery.…”

mentioning

confidence: 85%

Stenting of a renal artery compressed by the diaphragm

et al. 2003

View full text Add to dashboard Cite

A 74-year-old man had a resistant hypertension with an increase in plasma aldosterone and active plasma renin levels, and an irregular appearance of the left kidney outline by ultrasound. The CT scan showed a stenosis of the left renal artery, which was pushed against the aorta by the left crus of the diaphragm. An angioplasty with placement of an autoexpansible stent was carried out with a good result on the arterial pressure level. After 3 years, the patient was re-hospitalised with severe hypertension. The CT scan demonstrated a compression of the stent by the left crus of the diaphragm, with good permeability of the artery downstream from the stent, and radiographic examination showed a fracture of the left renal artery stent. Thus, a reimplantation of the left renal artery in the aorta was carried out. Stenosis of the renal artery by fibres from a crus of the diaphragm is a rare cause of renovascular hypertension. Helicoidal angioscanner imaging is particularly useful to do the diagnosis. In the present case, renal angioplasty with stenting was complicated by a fracture of the stent that led to the surgery. Thus, when renal artery stenosis by a crus of the diaphragm is diagnosed, surgical treatment needs to be considered on a case-by-case basis in relation to the anatomy and the biological and functional data. Keywords: renal artery; compression; crus of the diaphragm; stenting A 74-year-old man presented with a 30-year history of hypertension (HT) that was resistant to triple therapy with bisoprolol 10 mg, nicardipine 100 mg and hydrochlorothiazide 25 mg per day. He had given up smoking 5 years previously (30 pack-years) and did not have diabetes or hyperlipidaemia. He was asymptomatic apart from some headaches. The ECG showed sinus rhythm, right bundle branch block and left ventricular hypertrophy. Systolic left ventricular function was normal by ultrasound, but there was severe left ventricular hypertrophy. Serum creatinine was 81 mmol/l (No115) and renal ultrasound showed symmetrical kidneys (110 mm in the long axis) with an irregular left kidney outline. After 15 days of dual therapy with bisoprolol and nicardipine, there was hypokaliaemia at 3.3 mmol/ l, an increase in plasma aldosterone to 509 pmol/l (No333) and active plasma renin to 18 ng/l (No16) in the lying position. A CT scan of the renal arteries confirmed the irregular left kidney and demonstrated a stenosis of the left renal artery which was pushed against the aorta by the left crus of the diaphragm (Figure 1). Arteriography confirmed 90% stenosis in the diameter of the left renal artery. An angioplasty with placement of an autoexpansible stent (Wallstent 6 Â 28 mm, Boston Scientific, Galway, Ireland) was carried out with a good angiographic result. The radioscopic examination at the end of the procedure showed a compression of the stent in its mid-part. The compression appeared on inspiration ( Figure 2) and disappeared on expiration. The blood pressure which was at 210/ 100 mmHg before renal angioplasty was reduced to 150/70 mmHg after the...

show abstract

“…Flow in the GDA can thus be a direct marker of the real haemodynamic impact of CA stenosis on the hepatic vascularization and could participate in the pre-surgical workup of duodenopancreatectomy (in which a ligation of the GDA is often mandatory) or liver transplantation [7][8][9] in order to avoid unnecessary revascularization of a non-haemodynamically significant CA stenosis. Currently, this pre-operative assessment is mainly based on morphological assessment of the degree of CA stenosis and diameter of the GDA, preferentially performed by CT. 11,[23][24][25][26] This led Sugae et al, 10 based on a retrospective study comparing the pre-operative morphological grading of CA stenosis with required revascularization procedures during pancreatic surgery, to recommend: ,50% stenosis, no additional procedure; between 50% and 80%, release of the MAL if present; and .80% stenosis, reconstruction of the coeliac arterial axis. This recommendation could be modified according to our results.…”

Section: Discussionmentioning

confidence: 99%

Phase-contrast MRI evaluation of haemodynamic changes induces by a coeliac axis stenosis in the gastroduodenal artery

Haquin

Sigovan

Mabrut

et al. 2017

BJR

View full text Add to dashboard Cite

Objective: To evaluate the correlation between the gastroduodenal artery (GDA) haemodynamic changes and the degree of coeliac axis (CA) stenosis using phasecontrast MRI. Methods: The study was institutional review board approved, and written informed consent was obtained from patients included prospectively. A two-dimensional phase-contrast MRI was performed in 23 patients scheduled for a potential complex supramesocolic surgery, in a plane perpendicular to the GDA, during inspiration and expiration. The peak and mean velocities (V p and V m ), mean flow rate (Q m ) and flow direction at inspiration and at expiration have been correlated with the degree of CA stenosis evaluated by CT. Results: 13 of 23 patients presented CA stenosis due to the median arcuate ligament (34-80% of stenosis), 4 of them had associated atheromatous calcifications. V p , V m and Q m of GDA presented a significant and linear relationship with the degree of CA stenosis, at inspiration as well as at expiration (r . 0.74, p , 0.001). Velocities and flow rates presented a different pattern depending on the degree of CA stenosis: ,34% (n 5 10), flow direction remained physiological with low velocities and flow rates; .60% of stenosis (n 5 5), a reverse flow direction with increased velocities and flow rates were observed; variable patterns between 34% and 60%. Conclusion: Phase-contrast MRI permits the evaluation of haemodynamic changes in GDA induced by CA stenosis, including median arcuate ligament compression, and could be of great interest in therapeutic decision making in supramesocolic surgery, such as liver transplantation or duodenopancreatectomy, by detecting haemodynamically significant stenoses. Advances in knowledge: Physiological phase-contrast MRI detects haemodynamically significant stenoses of the CA by evaluating haemodynamic parameters in the GDA. Physiological phase-contrast MRI demonstrates that flow in the GDA can be a direct marker of the real haemodynamic impact of a CA stenosis on the hepatic vascularization and could thus participate in the presurgical work-up of duodenopancreatectomy or hepatic graft, whereas existing pre-operative imaging are only morphological.

show abstract

Median arcuate ligament syndrome with multivessel involvement: diagnosis with spiral CT angiography

Cited by 62 publications

References 4 publications

Renal artery entrapment — anatomical risk factors rating

Renal artery entrapment — anatomical risk factors rating

Stenting of a renal artery compressed by the diaphragm

Phase-contrast MRI evaluation of haemodynamic changes induces by a coeliac axis stenosis in the gastroduodenal artery

Contact Info

Product

Resources

About