PS160. Management of Median Arcuate Ligament Syndrome (MALS) with Decompression and Coeliac Ganglion Sympathectomy (CGS) for Chronic Mesenteric Ischaemia (CMI). Procedural, Clinical and Enduring Results With Quality-Adjusted Time Spent Without Symptoms of Disease and Toxicity of Treatment (Q-TWiST)

Abstract

Objectives: Knowledge of peripheral vascular disease (PVD) risk factors and their modification may impact disease progression and outcome. Our purpose was to determine if there was a difference in patient awareness based on insurance status and what subpopulations benefit most from screening.Methods: 916 asymptomatic patients were screened for carotid stenosis, abdominal aortic aneurysm, and/or PVD. Knowledge about risk factors for vascular diseases were assessed via questionnaires. Insurance status, medications, symptoms of PVD, and past medical history were queried. Data were analyzed with Chi squared and logistic regression, and statistical significance set at p Ͻ 0.05.Results: Patients were mostly female (71.1%), Caucasian (86.1%), Hispanic (85.8%), and uninsured (47.8%). Insurance status was associated with improved knowledge of PVD risk factors including diabetes mellitus (p Ͻ 0.001), hypertension (p ϭ 0.003), and family history (p Ͻ 0.001). Non-Hispanics exhibited better education (diabetes mellitus p Ͻ 0.001, family history p Ͻ 0.001). Feet pallor, coolness, numbness and tingling, and lower extremity claudication correlated with abnormal ABI (p ϭ 0.001, 0.021, 0.028, and 0.001, respectively). Feet pallor and claudication were independent predictors of PVD (OR ϭ 2.70, CI 1.01 -7.23, and OR 3.09, CI 1.21 -7.90, respectively). Additionally, diabetes, hypertension, smoking, history of myocardial infarction, and hyperlipidemia correlated with PVD (p Ͻ 0.001, Ͻ 0.001, ϭ 0.015, 0.013, and Ͻ 0.001, respectively).Conclusions: These data suggest a difference in knowledge of PVD risk factors depending on insurance status. In addition, patients with risk factors such as smoking, diabetes, hypertension and hyperlipidemia are in need of early screening.Objectives: CMI due to MALS is an erratic entity yet it is an imperative trigger of abdominal pain, often arduous to diagnose and challenging to treat. Theories invoking neuro-vascular origin have been proposed.Methods: We appraised our encounter in treating such proviso over 8-year period. Follow-up was done by duplex ultrasound surveillance and clinical assessment at 6-monthly intervals, as well as completion of Quality of Life questionnaires. Mean age was 51 (19-70) years, M:F ratio was 1:9, 4 of 10 patients were smokers but all were none diabetics, mean BMI was 19.4Kg/m2 and mean duration of symptoms prior to surgery was 2.6years. 10 patients were treated for CMI with MAL decompression and CGS. Three had mesenteric reconstruction, Coeliac to SMA, aorta to SMA and SMA to celiac bypass.Results: Mean hospital stay was 48hours. There was no morbidity or mortality. Symptomatic response with resolution of symptoms was seen in all patients, although a sustained weight gain was noted in six patients, all of whom had MAL decompression with CGS but no reconstruction. At a mean of 26 months follow-up, duplex ultrasound showed high velocity in the celiac axis in 50% of patients. However this did not correlate with return of symptoms, with 71% of patients remaining symptom free a...

Median arcuate ligament syndrome (Dunbar syndrome): A diagnosis not to be underestimated

“…Reduced blood flood through this artery is thought to be accountable for the variety of symptoms observed in this syndrome. Celiac ganglion compression in MALS is a contributory factor [ 5 , 6 ].…”

“…Neuropathic pain is thought to be an aggravating factor in MALS. This is explained by the fact that the celiac ganglion is located close to the celiac artery [ 5 , 6 ]. MALS is more common in women (sex ratio = 4:1) aged between 30 and 50 years old [ 6 – 10 ].…”

“…This is explained by the fact that the celiac ganglion is located close to the celiac artery [ 5 , 6 ]. MALS is more common in women (sex ratio = 4:1) aged between 30 and 50 years old [ 6 – 10 ]. No other risk factors have been found in literature.…”

Two Decades of Experience With Chronic Mesenteric Ischaemia and Median Arcuate Ligament Syndrome in a Tertiary Referral Centre: A Parallel Longitudinal Comparative Study

“…Our experience spanned nearly two decades, and almost all of our MALS patients were cured after the surgical intervention compared to CMI [ 9 ]. None of our adult patients was diagnosed with any previous psychiatric illness.…”

“…Delis et al [ 27 ] contraindicated the use of angioplasty and stenting primarily in patients with MALS without the prior release of MAL and stiff para-aortic ganglia tissue with surgery. Based on our experience [ 9 , 16 ], any external pressure on the CA by the surrounding dense neuro-fibrous tissue compounded by the diaphragmatic critical shuttering will permit slipping of the stent or its fracture and recurrence of symptoms and signs within a short period. Furthermore, stents are crushed and displaced by the MAL if it is not fully decompressed.…”