Median arcuate ligament syndrome: surgical approaches to a rarely diagnosed and undertreated disease

Skelly, Christopher L.; Mak, Grace Z.

doi:10.1016/j.jvs.2022.11.046

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…Compression of the celiac artery is most severe at the end of expiration, with a corresponding marked increase in flow velocities [ 4 , 9 ]. The combination of a peak systolic velocity of greater than 350 cm/s at end-expiration and an angle of less than 50° between the celiac artery and aorta is a reliable indicator of MALS on ultrasound [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Superior Mesenteric Artery Thrombosis in a Patient With Median Arcuate Ligament Syndrome

Cassim,

Diljohn,

Rampersad

et al. 2023

Cureus

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Median arcuate ligament syndrome (MALS) is a rare and controversial vascular compression syndrome. In this condition, the median arcuate ligament compresses the celiac artery, resulting in symptoms such as postprandial abdominal pain, vomiting, and weight loss. Its diagnosis is based on clinical findings in conjunction with supporting radiological features such as elevated flow velocities on Doppler ultrasound and focal indentation of the proximal celiac artery with the typical 'hooked' or 'J'-shaped appearance on conventional angiography or computed tomography angiography (CTA). Herein is the case of a 44-year-old female who presented with early satiety, postprandial abdominal pain, vomiting, and weight loss. A computed tomography mesenteric angiogram (CTMA) showed thickening of the median arcuate ligament with a hooked appearance of the celiac artery and thrombosis of the mid to distal superior mesenteric artery with associated ischemia of a short segment of the jejunum. Subsequent Doppler ultrasound demonstrated elevated peak systolic velocities within the celiac artery over the compressed segment, which varied with respiration (end-inspiration: 234.3 cm/s and end-expiration: 373.5 cm/s).

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Section: Discussionmentioning

confidence: 99%

Superior Mesenteric Artery Thrombosis in a Patient With Median Arcuate Ligament Syndrome

Cassim,

Diljohn,

Rampersad

et al. 2023

Cureus

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“…Third, MALS is highly comorbid with psychological symptoms and psychiatric disorders ( Mak et al, 2016 ). These comorbidities can distract from accurate diagnosis (e.g., providers focusing on anxiety symptoms for pain etiology) ( Stiles-Shields et al, 2021 ); as well as create barriers to seeking and/or maintaining care ( Skelly and Mak, 2023 ). Further, surgical intervention for MALS does not appear to resolve psychological symptoms and psychiatric disorders for pediatric or adult patients ( Skelly et al, 2018 ; Stiles-Shields et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Median arcuate ligament syndrome: a cost analysis to determine the economic burden of a rarely diagnosed disease

Skelly,

Stiles-Shields,

Goldenthal

et al. 2024

Front. Psychol.

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BackgroundChronic abdominal pain (CAP) is a medical condition resulting in enormous economic burden and healthcare utilization costs. One understudied source of CAP is the median arcuate ligament syndrome (MALS). MALS is often not diagnosed and treated for a variety of reasons, including the fact that MALS is highly comorbid with psychological symptoms and psychiatric disorders similar to CAP. To better inform future work on the study of MALS, we undertook a pilot study to estimate the economic impact and public health burden of this condition. We hypothesized that MALS imposes a significant public health burden.MethodsPediatric and adult patients enrolled in a prospective study undergoing multidisciplinary evaluation and treatment for MALS at a tertiary care facility were invited to participate in a brief self-report survey, the Direct and Indirect Medical Care Impact of MALS Form, to capture health care resources including procedures, surgeries, health care visits, and absenteeism (school and work). To estimate costs from the Direct and Indirect Medical Care Impact of MALS Form, the medical care usage data self-reported by patients were converted to dollar value utilizing FSC-93 billing data and corresponding current procedural terminology (CPT) codes for procedures and provider visits one year prior to surgery and then following surgery. Descriptive analyses were conducted to characterize the sample in terms of demographics and reported absences from school and work.ResultsOne hundred and nineteen patients (mean age = 30.9 ± 13.0) completed the questionnaires, yielding a 57% response rate. 82.4% (n = 98) of the participants were female and 90.8% (n = 108) were non-Hispanic/Latine white. The mean and median surgical follow-up periods were 5.3 and 5.4 years, respectively. Overall, median cost of provider and ancillary healthcare provider visits for each patient was (US)$19,119 including the pre-operative and post-operative visits. The mean cost for providers alone was (US)$28,908. Wilcoxon signed-ranks tests indicated that the postoperative missed number of days of school were significantly lower than the pre-surgical number of missed school days (Z = −3.36, p = 0.001). Similarly, there were significantly less missed work-days following surgery than before for the entire sample (Z = −2.86, p = 0.004).ConclusionMedian arcuate ligament syndrome imposes a large economic burden on patients and the healthcare system. The current findings, although reflective of a homogenous population, are adding to a growing body of literature suggesting that healthcare disparities play a role in the low rates of diagnosis and treatment of MALS.

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Institutionalized Adoption of a Protocol for the Management of Median Arcuate Ligament Syndrome Correlates with Improved Surgical Outcomes

Lanka,

Hakaim,

Bowers

et al. 2025

Annals of Vascular Surgery

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Median arcuate ligament syndrome: surgical approaches to a rarely diagnosed and undertreated disease

Cited by 4 publications

References 6 publications

Superior Mesenteric Artery Thrombosis in a Patient With Median Arcuate Ligament Syndrome

Superior Mesenteric Artery Thrombosis in a Patient With Median Arcuate Ligament Syndrome

Median arcuate ligament syndrome: a cost analysis to determine the economic burden of a rarely diagnosed disease

Institutionalized Adoption of a Protocol for the Management of Median Arcuate Ligament Syndrome Correlates with Improved Surgical Outcomes

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