A Severe Case of Median Arcuate Ligament Syndrome with Successful Angioplasty and Stenting

Abstract

Median arcuate ligament syndrome (MAL) or celiac axis compression syndrome (CACS) is a rare etiology of chronic abdominal pain. Traditional treatment of this syndrome is surgery. We report a case of median arcuate ligament syndrome with a severe compression of the celiac trunk, which was successfully treated by angioplasty with stenting.

The investigation of incidence and multidetector computed tomography findings of median arcuate ligament syndrome

“…Cutting the MAL by open or laparoscopic surgery reduces the morbidity and mortality rates and these are conventional procedures with high success rates (18). On the other hand, different treatment modalities such as patch angioplasty, aortoceliac bypass, aortoceliac artery reanastomosis, percutaneous endovascular interventions, balloon dilatation, stent placement, and endoscopic retroperitoneal approach may be instituted in the absence of conventional methods (19)(20)(21)(22). Prolonged follow-ups after surgical treatment have provided a success incidence rate of 70% to 80% (14).…”

Median Arcuate Ligament Syndrome: A Cause of Postprandial Abdominal Pain in a Patient With Ulcerative Colitis

“…The typical treatment is laparoscopic division of the median arcuate ligament to relieve the extrinsic compression [6]. Percutaneous endovascular treatment is an alternative technique [7]. Our patient was treated with laparoscopic lysis of her arcuate ligament and had a complete remission of her abdominal symptoms.…”

Celiac artery compression syndrome. Mini-review

“…After re-diagnosis and visualization of celiac artery stenosis, endovascular treatment based on celiac artery PTA with possible stent implantation should be considered. The abovementioned practice was successful in two reported cases and in the follow-up period of 6 and 15 months, symptoms have not reappeared [5,21].…”

“…The disease is caused by overgrowth of inferiorly placed median arcuate ligament of the diaphragm, causing celiac artery compression during the expiration phase. It can cause symptoms of "abdominal claudication" [4,5]. An intrinsic component of the disease's pathogenesis is the irritation of the celiac plexus fibers by the overgrown ligament.…”