Retroperitoneal endoscopic release in the management of celiac artery compression syndrome

Abstract

The endoscopic retroperitoneal approach for the release of the CA in CACS, with additional endovascular treatment of persistent stenosis, is feasible and effective. Short-term results were comparable with the open procedure.

Open or percutaneous revascularization for chronic splanchnic syndrome

“…8,9 Intraluminal stenoses must be differentiated from extraluminal stenoses, which is mostly caused by compression of the celiac artery by the arcuate ligament. 10 Isolated endovascular treatment in these patients is contraindicated without foregoing appropriate cleavage of the arcuate ligament. [11][12][13][14][15] For many decades, the broad consensus was that timely diagnosis and appropriate revascularization diminished the high mortality of acute splanchnic syndrome and in case of CSS, could durably restore the symptoms.…”

Laparoscopic treatment of renal artery entrapment

“…After laparoscopic aortic surgery became more widespread, a growing number of patients with celiac artery compression have been treated with this minimally invasive approach, either transperitoneally or retroperitoneally. 6,15,16 Using the transperitoneal retrorenal dissection in laparoscopic aortic surgery, 17,18 with the left renal artery acting as a landmark, it appears obvious to treat LRA entrapment by a laparoscopic approach with the following potential advantages: less access trauma, improved view, reduced operation time, shorter recovery, and better cosmetic results. Furthermore, the particular attraction of laparoscopic surgery might be to combine minimally invasive treatment for both TC and LRA entrapment.…”

“Re: Management of Median Arcuate Ligament Syndrome: A New Paradigm”

“…The conversion rate to open surgery varied between 13-27% in the transabdominal laparoscopic group, 2,3 as compared with 2% in the retroperitoneal endoscopic release group. 4 The main reason for conversion was intraoperative bleeding. In the largest series, 4 after retroperitoneal endoscopic release, unimpeded vessel anatomy during respiration was observed on angiography in 78%.…”

“…4 The main reason for conversion was intraoperative bleeding. In the largest series, 4 after retroperitoneal endoscopic release, unimpeded vessel anatomy during respiration was observed on angiography in 78%. Six patients with persisting intraluminal stenoses after release underwent supplementary endovascular angioplasty resulting in a primary-assisted anatomic patency of 89%.…”

“…We observed GERD in 9% after open CACS release as opposed to 0% in the retroperitoneal approach. 4,5 Furthermore, Duffy et al mentioned peroperative assessment of the artery by laparoscopic ultrasound imaging after decompression. It is arguable whether general anesthetic with muscle relaxation makes it possible to assess respiration-dependent flow changes.…”