Compression of the Celiac Artery by the Median Arcuate Ligament: Multidetector Computed Tomography Findings and Characteristics

2015 ◽  
Vol 66 (3) ◽  
pp. 272-276 ◽  
Author(s):  
Ozdil Baskan ◽  
Emre Kaya ◽  
Fatma Zeynep Gungoren ◽  
Cengiz Erol
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Dominant Role ◽  
Gastrointestinal Symptoms ◽  
Celiac Artery ◽  
Arterial Phase ◽  
Control Group ◽  
Median Arcuate Ligament ◽  
Arcuate Ligament ◽  
Atherosclerotic Changes

Purpose The prevalence of the celiac artery stenosis caused by median arcuate ligament (MAL) compression and its multidetector computed tomography (MDCT) characteristics were evaluated in patients who underwent abdominal MDCT procedures, retrospectively. Methods Totally 1121 patients who had abdominal MDCT with arterial phase or MDCT angiography of the abdominal aorta for various indications were analyzed for celiac artery compression by the MAL. Results Fifty (ie, 4.6%) patients showed typical MDCT features of MAL compression. Focal narrowing of the proximal celiac artery, a characteristic hooked appearance of the narrowed segment without calcification and atherosclerotic changes were diagnostic. Poststenotic dilatation was detected in 22 (44%) patients with MAL compression. The ratio of the stenosis of the celiac artery was between 35%-50% in 15 patients and 51%-80% in 35 patients. The gastroduodenal artery diameter of these patients was not significantly different from the asymptomatic control group. Conclusion MALS is an uncommon entity but it should be kept in mind in the presence of unexplained gastrointestinal symptoms. MDCT is a minimally invasive and plays a dominant role in the diagnosis of MAL compression especially with reformatted and 3-D reconstructed images.

scholarly journals Median Arcuate Ligament Syndrome: A Case Report

2018 ◽  
Vol 21 (2) ◽  
pp. 38-39
Author(s):  
Akash Chitrakar ◽  
Nirajan Subedi ◽  
Ramesh Singh Bhandari
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Epigastric Pain ◽  
Celiac Artery ◽  
Celiac Axis ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Celiac Ganglion ◽  
Extrinsic Compression ◽  
Arcuate Ligament

Median arcuate ligament (MAL) syndrome results from extrinsic compression of the celiac axis and or celiac ganglion by the MAL and diaphragmatic crura. A seventy five years lady presented with post prandial epigastric pain for 6 months. She had undergone considerable investigations for other diagnoses before an abdominal computed tomography (CT) revealed median arcuate ligament impinging celiac artery at its origin. She successfully underwent laparotomy and release of median arcuate ligament.  

Abstract P064: Case Report of Mals Surgery in Postural Orthostatic Tachycardia Syndrome

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Chandralekha Ashangari ◽  
Amer Suleman
Keyword(s):  
Heart Rate ◽  
Operative Procedure ◽  
Gastrointestinal Symptoms ◽  
Celiac Artery ◽  
Exercise Intolerance ◽  
Tilt Test ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Median Arcuate Ligament ◽  
Extrinsic Compression ◽  
Arcuate Ligament

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia associated with variety of symptoms like Headache, Abdominal discomfort, Dizziness/presyncope, Nausea, Fatigue, Lightheadedness, Sweating Sleep disorder, Tremor, Anxiety, Palpitations, Exercise intolerance. Median arcuate ligament syndrome (MALS, also known as celiac artery compression syndrome) is a condition characterized by abdominal pain, delayed gastric emptying, nausea, weight loss and other symptoms of autonomic dysfunction attributed to compression of the celiac artery and possibly the celiac ganglia by the median arcuate ligament. The researchers suggest that MALS should be considered in POTS patients who have persistent gastrointestinal symptoms. The purpose of this research is to study the celiac artery velocity in POTS patients. That led us to think about an operative procedure that can reduce POTS symptoms through MALS surgery. Patients and Method: We present the case of a 17 year old male with POTS symptoms not improving with medical management and celiac artery ultrasound positive for MALS.His celiac artery velocities was higher in Inspiration as well as Expiration and MALS is confirmed with CT angiogram.He underwent laparoscopic MALS surgery where the Median arcuate ligament is flipped thereby decreasing the extrinsic compression on the celiac artery. Results: There appears to be tremendous improvement in the patient’s symptoms after the surgery for MALS.His nausea had almost disappeared.Before surgery he had vomiting twice a week, after surgery he had vomiting four times in three months. His lightheadedness had disappeared. Bluish discoloration of arms and feet when he used to stand had disappeared in the hospital after the procedure. Sensations of hands had improved. Heat intolerance had improved. His Sleep and constipation improved. There was no much improvement in fatigue. Autonomic tilt table test is repeated after surgery to see if there is definite objective change, Heart rate in the first 10 minutes of tilt test before the surgery was >120bpm,Heart rate after the surgery was <100 bpm. Conclusions: Laparoscopic MALS surgery was found to be extremely helpful in relieving POTS symptoms with immediate results.

Clinical and multidetector computed tomography findings of patients with median arcuate ligament syndrome

2012 ◽  
Vol 36 (5) ◽  
pp. 522-525 ◽  
Author(s):  
Hatice Gümüş ◽  
Metehan Gümüş ◽  
Güven Tekbaş ◽  
Hakan Önder ◽  
Faysal Ekici ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament

scholarly journals Laparoscopic treatment for celiac artery stenosis caused by median arcuate ligament compression with Adachi V type vascular anomaly: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hiroshi Saito ◽  
Koichiro Sawada ◽  
Jyunichi Ogawa ◽  
Masashi Hashimoto ◽  
Masahiro Oshima ◽  
...  
Keyword(s):  
Epigastric Pain ◽  
Vascular Anomaly ◽  
Celiac Artery ◽  
Artery Stenosis ◽  
Laparoscopic Treatment ◽  
Median Arcuate Ligament ◽  
Case Presentation ◽  
Arcuate Ligament ◽  
Major Vascular Injury

Abstract Background Median arcuate ligament syndrome (MALS), which results from compression of the median arcuate ligament (MAL), is a rare cause of abdominal pain and weight loss. Treatment is dissection of the MAL; however, the laparoscopic procedure is not yet established and it involves the risk of major vascular injury, especially in cases with an anomaly. Case presentation A 47-year-old man was evaluated at the hospital for epigastric pain. Contrast computed tomography scan revealed stenosis of the celiac artery origin due to the MAL. An Adachi V type vascular anomaly was also observed. Laparoscopic treatment was performed to release pressure on the celiac artery. Laparoscopic ultrasonography was used to less invasively confirm the release of the MAL. Despite a concomitant Adachi V type vascular anomaly, surgery was safely performed using the laparoscopic magnification view and intraoperative ultrasonography. Follow-up ultrasonography confirmed the celiac artery stenosis has not recurred. Conclusions A rare case of MALS with an Adachi V type vascular anomaly is presented and the laparoscopic treatment is detailed.

Detailed anatomy and procedure of celiac artery decompression in median arcuate ligament syndrome

2021 ◽  
Author(s):  
Kyoji Ito ◽  
Nobuyuki Takemura ◽  
Ryo Oikawa ◽  
Fuyuki Inagaki ◽  
Fuminori Mihara ◽  
...  
Keyword(s):  
Celiac Artery ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament

scholarly journals A Case of Carcinoma of the Papilla of Vater Accompanied with a Stricture of the Celiac Artery by the Median Arcuate Ligament

2008 ◽  
Vol 41 (8) ◽  
pp. 1588-1593 ◽  
Author(s):  
Kiichiro Mogami ◽  
Toshiaki Ichihara ◽  
Tsutomu Sato ◽  
Satoshi Shibata ◽  
Tomokazu Takahashi ◽  
...  
Keyword(s):  
Celiac Artery ◽  
Papilla Of Vater ◽  
Median Arcuate Ligament ◽  
Arcuate Ligament

Assessment of celiac artery compression using color-coded duplex sonography

2020 ◽  
Vol 76 (3) ◽  
pp. 413-423 ◽  
Author(s):  
Claudia Römer ◽  
Thomas Fischer ◽  
Oliver Haase ◽  
Martin Möckel ◽  
Bernd Hamm ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Peak Systolic Velocity ◽  
Rare Condition ◽  
Diagnostic Value ◽  
Celiac Artery ◽  
Breath Hold ◽  
Median Arcuate Ligament ◽  
Diagnostic Modality ◽  
Cross Sectional ◽  
Arcuate Ligament

BACKGROUND: Median arcuate ligament syndrome (MALS) is a rare condition due to compression of the celiac artery (CA) by an anatomically abnormal median arcuate ligament. With ultrasonography (US) as first-line diagnostic modality in patients with unclear abdominal pain, there is limited data on its diagnostic performance in MALS. OBJECTIVE: To investigate the value of CA peak systolic velocity (PSV) in the workup of patients with suspected MALS. METHODS: Patients with diagnosis of MALS between 2009 and 2019 were referred by Department of Visceral Surgery after clinical and gastroenterological workup. Diagnosis was confirmed by surgery or further cross-sectional imaging. B-mode US findings and PSV in the CA during various respiratory states were compared between patients with a final MALS diagnosis and patients not meeting the diagnostic criteria. RESULTS: Patients with proven MALS (n = 10) had higher median CA PSV during normal inspiratory breath-hold (239 [IQR, 159–327] vs. 138 [IQR, 116–152] cm/s; p < #x003C;< #x200A;0.001), and expiratory breath-hold (287 [IQR, 191–412] vs. 133 [IQR, 115–194] cm/s; p < #x003C;< #x200A;0.001) compared to patients without MALS (n = 26). CA PSV in both inspiratory breath-hold (AUC 0.88, 95% CI 0.77–1.00) and expiratory breath-hold (AUC 0.89, 95% CI 0.78–1.00) was of diagnostic value for confirming MALS. The best diagnostic performance (100% sensitivity, 80% specificity) was found for the combination of CA PSVexpiration + 2.4 · PSVinspiration > 550 cm/s . CONCLUSIONS: Since results on optimal cutoff values are inconsistent, a combination of CA PSVs during breathing maneuvers may help to diagnose or rule out MALS.

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