Laparoscopic treatment of median arcuate ligament syndrome

Sun, Zhipeng; Zhang, Dongdong; Xu, Guangzhong; Zhang, Nengwei

doi:10.5582/irdr.2019.01031

Cited by 24 publications

(21 citation statements)

References 25 publications

(30 reference statements)

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“…1,7 Invasive mesenteric DSA, with multiple orthogonal views, allows dynamic visualization of the arterial compression using respiratory maneuvers. 2,7 In this case, 50% stenosis of the SMA was seen in addition to occlusion of the celiac axis. This concurrent compromise of both foregut and midgut blood flow in MALS has been scarcely reported in the literature 9,10 and may be an important indicator for greater disease severity.…”

Section: Discussionmentioning

confidence: 64%

“…This is seen anatomically in 10% to 24% of the population but is symptomatic in only a small proportion (2/100,000 patients). [1][2][3] Symptoms most commonly affect young women between 20 and 40 years of age; it typically is manifested with nonspecific postprandial abdominal pain, vomiting, and weight loss. 1,2 Diagnosis is challenging and often made after exclusion of other causes.…”

mentioning

confidence: 99%

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Intravascular ultrasound-guided laparoscopic division of the median arcuate ligament

Bayat

Wang

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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Median arcuate ligament syndrome is a rare and poorly understood condition that can have a significant impact on the quality of life of patients. Diagnosis is often difficult and delayed because of the need to exclude other pathologic processes. Treatment strategies traditionally involve open or laparoscopic division of the median arcuate ligament, with or without vascular reconstruction. This report portrays a case of median arcuate ligament syndrome with compression of two visceral arteries and distal embolic complications. A novel hybrid technique is described using intravascular ultrasound technology to aid in laparoscopic median arcuate ligament division. This allowed real-time intravascular visualization of the compressive segment, guided release of the ligament fibers, and demonstrated confirmation of decompression. (J Vasc Surg Cases and Innovative Techniques 2020;6:147-51.)

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Section: Discussionmentioning

confidence: 64%

mentioning

confidence: 99%

Intravascular ultrasound-guided laparoscopic division of the median arcuate ligament

Bayat

Wang

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…Several authors have confirmed that adequate selection of patients is the most important factor to improve surgical treatment outcome 9,22 .However, selecting patients who are likely to benefit from surgery is a challenge. As in our series, combination of extensive medical evaluation to exclude other diseases and typical findings of high grade of celiac trunk stenosis on angiographyis of paramount importance to diagnose MALS.…”

Section: /4mentioning

confidence: 99%

“…Sustained symptom relief has been reported in 80% to 100% of patients with MALS who underwent surgical decompression, depending on several factors, including patients' selection and severity of celiac trunk stenosis 5,10,19 . Roseborough 19 reported subjective improvement of symptoms in 14 (93%) of 15 patients treated laparoscopically, with a mean follow-up period of 44.2 months.The followingclinical factors may indicatebetter prognosis: postprandial abdominal pain, age between 40 and 60 years, weight loss greater than 20 pounds, and absence of history of mental illness or alcohol abuse 22 .…”

Section: /4mentioning

confidence: 99%

“…Severe complications such as ruptured pseudo-aneurysm of the inferior pancreatic-duodenal artery have also been reported 15,21 . The most usual treatment of this condition is surgical decompression of the celiac axis by sectioning the median arcuate ligament 5,19,22 . Since the first release of the celiac axis through laparoscopy by Roayaie et al 17 in 2000, this access became the standard treatment of MALS.…”

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confidence: 99%

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Treatment of median arcuate ligament syndrome: outcome of laparoscopic approach

Coelho

Hosni

Claus

et al. 2020

ABCD, arq. bras. cir. dig.

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Background: Median arcuate ligament syndrome(MALS) is a rare condition thatmay cause significant clinical manifestations, including abdominal pain and weight loss. Its diagnosis may be difficult and very often delayed. The laparoscopic approach became the standard treatment of MALS. Aim: To assess the outcome of laparoscopic treatment in patients with MALS. Method: The data of sixpatients with MALS who were subjected to laparoscopic sectioning of the median arcuate ligament were retrospectively reviewed.The following data were evaluated: age, gender, clinical and diagnostic tests findings, ASA score, operative findings and complications, postoperative complications and mortality, hospital stay duration, and hospital readmission.The diagnosis of MALS was established by CT angiography and/or MR angiography. Results: There were four (66.7%) women and two (33.3%) men aged from 32 to 60 years. The main symptoms were epigastric pain (100%) and weight loss (66.7%). The findings of high-grade stenosis of the proximal celiac axis and poststenotic dilation confirmed on angiography confirmed the diagnosis in all patients. Surgical procedure was uneventful in all patients. The only postoperative complication was urinary retention that occurred in a male. At three-month follow-up, all patients were asymptomatic. Conclusion: Laparoscopic treatment of MALS is safe and effective in relieving the clinical manifestations of patients.

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Numerical simulation in the abdominal aorta and the visceral arteries with or without stenosis based on 2D PCMRI

Chen

Liu

et al. 2022

Numer Methods Biomed Eng

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It is important to obtain accurate boundary conditions (BCs) in hemodynamic simulations. This article aimed to improve the accuracy of BCs in computational fluid dynamics (CFD) simulation and analyze the differences in hemodynamics between healthy volunteers and patients with visceral arterial stenosis (VAS). The geometric models of seven cases were reconstructed using the magnetic resonance angiogram (MRA) or computed tomography angiogram (CTA) imaging data. The physiological flow waveforms obtained from 2D Phase Contrast Magnetic Resonance Imaging (PCMRI) were imposed on the aortic inlet and the visceral arteries' outlets. The individualized RCR values of the three-element Windkessel model were imposed on the aortic outlet.CFD simulations were run in the open-source software: svSolver. Two specific time points were selected to compare the hemodynamics of healthy volunteers and patients with VAS. The results suggested that blood in the stenotic visceral arteries flowed at high speed throughout the cardiac cycle. The low pressure is distributed at stenotic lesions. The wall shear stress (WSS) reached 4 Pa near stenotic locations. The low time average wall shear stress (TAWSS), high oscillatory shear index (OSI), and high relative residence time (RRT) concentrated in the abdominal aorta. Besides, the ratios of the areas with low TAWSS, high OSI, and high RRT to the computational domain were higher in patients with VAS than which in the healthy volunteers. The individualized BCs were used for hemodynamic simulations and results suggest that patients with stenosis have a higher risk of blood retention and atherosclerosis formation in the abdominal aorta.

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Laparoscopic treatment of median arcuate ligament syndrome

Cited by 24 publications

References 25 publications

Intravascular ultrasound-guided laparoscopic division of the median arcuate ligament

Intravascular ultrasound-guided laparoscopic division of the median arcuate ligament

Treatment of median arcuate ligament syndrome: outcome of laparoscopic approach

Numerical simulation in the abdominal aorta and the visceral arteries with or without stenosis based on 2D PCMRI

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