Celiac Artery Decompression for Median Arcuate Ligament Syndrome: A United States National Inpatient Sample Study

Abstract

requiring dialysis, colonic ischemia requiring resection, limb ischemia requiring amputation, multisystem organ failure, or death. Endoleaks were classified in accordance with the standardized reporting practices of the Society for Vascular Surgery. Results: A total of 391 patients with complete family history and clinical data underwent elective AAA repair from 2004 to 2014. Demographics were consistent with a standard AAA population and did not differ between fAAA and spAAA patients. Sixty-two percent (n ¼ 56) of fAAA patients and 68% (n ¼ 203) of spAAA patients underwent EVAR (P ¼ .31). The fAAA patients did not incur any greater risk of major adverse events after EVAR (fAAA: 11% vs spAAA: 9%; P ¼ .8) or open AAA repair (fAAA: 11% vs spAAA: 15%; P ¼ .78). Despite no difference in major morbidity, the fAAA patients did have an increased rate of all types of endoleak (fAAA: 23% vs spAAA: 12%; P ¼ .05). Furthermore, the rate of type I endoleak and subsequent reintervention for type I endoleak did differ between the groups (fAAA: 7% vs spAAA: 1%; P ¼ .02). In contrast, reintervention for all types of endoleak after EVAR (fAAA: 13% vs spAAA: 8%; P ¼ .16) did not differ between fAAA and spAAA patients. Conclusions: The current study demonstrates that patients with fAAA do not have increased morbidity after AAA repair but are more prone to endoleak after EVAR. We believe our results, combined with those of others, suggest EVAR for fAAA is safe and effective but fAAA patients represent a subpopulation that would benefit from close postprocedural surveillance.

A nationwide analysis of median arcuate ligament release between 2010 and 2020: a NSQIP Study

“…Although the true incidence of the disease is unknown, Rezigh et al reported 33,951 cases of MALS were diagnosed in a 12 year period using the Nationwide Inpatient Sample [ 2 ]. Interestingly, in their study only 2.4% of all cases identified had undergone surgery.…”

“…Median arcuate ligament syndrome (MALS) is defined as a symptomatic extrinsic compression of the celiac axis caused by the median arcuate ligament (MAL) [ 1 ]. Often considered a rare entity, more recently a study using the Nationwide Inpatient Sample showed an increasing number of patients with this diagnosis [ 2 ]. There remains controversy regarding this diagnosis and its epidemiology, as celiac axis compression by the MAL can be found incidentally in up to 7.3% of patients who received cross-sectional abdominal imaging for other reasons [ 1 , 3 ].…”

Interprofessional Management of Median Arcuate Ligament Syndrome (Dunbar Syndrome) Related to Lumbar Lordosis and Hip Dysplasia: A Patient’s Perspective

“…Those who had CAD had much lower rates of comorbidities, with hypertension being the highest prevalence at 22.4% and the rest ranging from zero percent to 14%. Researchers of this study [ 23 ] asserted there is a need to educate physicians about these benefits of CAD surgery for patients with MALS. The high rates of comorbidities with MALS in this study [ 23 ] also showcases the extensive impact MALS has on multiple body systems.…”

“…Researchers of this study [ 23 ] asserted there is a need to educate physicians about these benefits of CAD surgery for patients with MALS. The high rates of comorbidities with MALS in this study [ 23 ] also showcases the extensive impact MALS has on multiple body systems. Thus far, there are no rigorous quantitative studies or descriptive qualitative studies about interprofessional management strategies for MALS available in the literature.…”

“…An addition, there are no studies that examine the connection between MALS and musculoskeletal conditions, which may be potential causes of MALS. While there are many case studies presented in the literature from a provider/researcher perspective, none of them were authentic from the patient’s perspective, describing the vast array of symptoms and co-morbidities [ 23 ] that many patients experience and struggle to manage. The purpose of this case is to highlight interprofessional management of MALS related to lumbar lordosis and hip dysplasia in order to support patients who are waiting for MALS release surgery or who are not candidates for surgery.…”