Median Arcuate Ligament Compression Associated with Flow-Related Visceral Aneurysms

Xiao, Nicholas; Ahuja, Arjun; Patel, Ricky; Desai, Shamit S; Nemcek, Albert A.; Resnick, Scott A.

doi:10.1016/j.jvir.2023.03.026

Cited by 3 publications

(3 citation statements)

References 15 publications

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“… 18 , 19 The largest case series of VAAs in patients with MALS demonstrated that inferior pancreaticoduodenal aneurysms were the most common (87.1%), with other VAAs being more rare. 20 Although SMA dissection associated with MALS has been reported, to the best of our knowledge, no studies have reported SMA aneurysms in patients with MALS. 21 , 22 …”

Section: Discussionmentioning

confidence: 91%

“… 4 In patients with MALS, an important collateral pathway between the CA and SMA is through the pancreaticoduodenal and dorsal pancreatic arteries, which are also the most common locations for aneurysms in MALS patients. 5 , 20 It is hypothesized that these arteries, specifically, are affected because they represent a collateral pathway and thus are exposed to higher flow when CA compression is present. 5 , 20 In the case of a CMT, the primary collateral pathway would not be in the pancreaticoduodenal arteries because both the CA and the SMA share a common origin but, rather, would be from the SMA and IMA, thus contributing to hypertrophied collateralization of the SMA and possible aneurysm formation.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 20 It is hypothesized that these arteries, specifically, are affected because they represent a collateral pathway and thus are exposed to higher flow when CA compression is present. 5 , 20 In the case of a CMT, the primary collateral pathway would not be in the pancreaticoduodenal arteries because both the CA and the SMA share a common origin but, rather, would be from the SMA and IMA, thus contributing to hypertrophied collateralization of the SMA and possible aneurysm formation. 9 , 10 This report provides a novel example of a patient with MALS and a CMT and highlights the adaptive vascular response and aneurysm development that can be associated with MALS and the presence of a CMT.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Superior mesenteric aneurysm associated with median arcuate ligament syndrome and a single celiacomesenteric trunk

Braet,

Pourak,

Davis

et al. 2023

Journal of Vascular Surgery Cases, Innovations and Techniques

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Superior mesenteric aneurysm associated with median arcuate ligament syndrome and a single celiacomesenteric trunk

Braet,

Pourak,

Davis

et al. 2023

Journal of Vascular Surgery Cases, Innovations and Techniques

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Aneurysmen der viszeralen Arterien bei Kompression des Lig. arcuatum medianum

2023

Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie,

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Two-Stage Endovascular Treatment of a Traumatic Pseudoaneurysm of Superior Mesenteric Artery Branch in a Soldier After a Military Combat Mission

Przemysław,

Uchto,

Maciąg

et al. 2023

Military Medicine

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Aneurysms and pseudoaneurysms of the visceral arteries are a rare pathology with a prevalence of 0.1-2% in the general population, most common in men. Despite low prevalence, visceral aneurysms pose a significant threat to the patient’s health and life; a ruptured superior mesenteric branch aneurysm carries mortality rates of 10-25% and up to 30-90%. This article presents a case of a 50-year-old former active duty soldier and veteran of a military combat mission in Afghanistan, during which he sustained a traumatic injury resulting from a mine explosion under a vehicle. After completing the mission and returning home, the patient developed abdominal pain. The diagnosis made in the general surgery department of the district hospital was upper gastrointestinal obstruction and aneurysmal rupture of the superior mesenteric branch with inflammatory infiltration of the pancreatic–intestinal area. The patient underwent emergency gastrointestinal anastomosis and Braun enteroenterostomy. The aneurysm was not resected. One month later, the patient underwent a follow-up abdominal angiotomography, which revealed an approximately 20-mm aneurysm of a branch of the superior mesenteric artery and celiac artery subocclusion (Dunbar syndrome) with extensive collateral circulation. A diagnosis of pseudoaneurysm/traumatic aneurysm was made, and the patient was referred to a vascular surgery center for endovascular treatment. Following CT angiography, a decision was made to perform a two-stage endovascular repair. The first stage was a bridge therapy aimed to release celiac artery subocclusion with a stent; after 3 weeks, pseudoaneurysm embolization was performed. The decision to use two-stage endovascular treatment was attributable to the risk of gastrointestinal ischemia that might result from intraoperative technical difficulties and complications, coil dislocation, and thrombosis of the superior mesenteric artery or its branch; the coexisting subocclusion of the celiac artery was also considered. The patient was discharged in good condition and returned to normal everyday activities. He also continued follow-up appointments with a vascular surgeon. An angiotomography performed at 1 year of endovascular treatment confirmed good effects of the embolization procedure and coagulation of the aneurysm. Visceral aneurysms are a rare vascular pathology but are associated with significant morbidity and mortality rates. The incidence of ruptured aneurysms is probably underestimated as some patients may be operated on for acute abdominal symptoms, e.g., bowel obstruction.

show abstract

Median Arcuate Ligament Compression Associated with Flow-Related Visceral Aneurysms

Cited by 3 publications

References 15 publications

Superior mesenteric aneurysm associated with median arcuate ligament syndrome and a single celiacomesenteric trunk

Superior mesenteric aneurysm associated with median arcuate ligament syndrome and a single celiacomesenteric trunk

Aneurysmen der viszeralen Arterien bei Kompression des Lig. arcuatum medianum

Two-Stage Endovascular Treatment of a Traumatic Pseudoaneurysm of Superior Mesenteric Artery Branch in a Soldier After a Military Combat Mission

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