Median arcuate ligament syndrome: vascular surgical therapy and follow-up of 18 patients

Abstract

The MALS is a rare vascular disorder caused by an extrinsic compression of the celiac artery and induces upper abdominal, mostly, postprandial pain. A definite diagnosis of MALS can be achieved by lateral aortography of the visceral aorta and its branches during inspiration and expiration. Open surgical therapy is a safe and reliable procedure with no mortality and low morbidity. As to the local and specific pathology of the celiac trunk after decompression with fixed stricture or stenosis, further vascular procedures are necessary. The long-time follow-up seemed adequate. The laparoscopic approach reduces the procedure of decompression only, something which seemed inadequate for most cases. Endovascular treatment with percutaneous transluminal angioplasty and insertion of a stent does not solve the underlying problem of extrinsic compression of the celiac trunk and often requires open procedures during the long-term course. Due to the low incidence of MALS, no guidelines will do justice to all the patients sufficiently, and the choice of treatment must depend on the specific clinical situation for each patient.

Celiac Trunk Stenosis Treated by Resection and Splenic Patch Reconstruction – A Case Report and Literature Review

“…Another interesting case reported in this series was that of a 20-year-old patient who redeveloped symptoms 3 months after initial surgery and in whom a transposition of the splenic artery in the supravisceral aorta was performed. After a mean follow-up period of 3.5 years, 11 patients were completely asymptomatic; however, among these cases, only six had been initially submitted only to decompression, in all the other cases, a degree of reconstructive surgery was also associated (19).…”

A rare cause of abdominal angina

“…Poststenotic dilation and collateral dilated vessels have the potential to evolve into aneurysms with risk of rupture and sudden death 5. Taking into consideration the impairment of quality of life and previous unsuccessful laparoscopic surgery, the evaluation of open surgery for decompression of the coeliac trunk with vascular reconstruction is a reasonable option 6. In a young patient, the triad of midabdominal bruit, weight loss and undiagnosed gastrointestinal symptoms might suggest MALS.…”

Celiac artery compression syndrome. Mini-review

“…CACS concerns mainly young people between 30 and 50 years of age, in particular women (75-91%) [7,13,18]. There are also reports of familial CACS.…”

“…Common symptoms include post-prandial epigastric pain, nausea, vomiting, and mild weight loss. Less frequently patients experience diarrhea, heartburn, abdominal bloating, constipation, arrhythmias and syncope [6][7][8][9].…”

“…In the case of pediatric patients under 21 years, University of Chicago Medicine is the leading institution, where 46 patients underwent laparoscopic surgery for the condition between 2008 and 2012 [13]. In University Hospital Dusseldorf, 18 patients with CACS were operated with open method from 2000 to 2009 [7]. In turn, 51 CACS-diagnosed patients were operated in San Francisco hospital until 1984 [14].…”