Celiac Artery Dissection and Retroperitoneal Hemorrhage in Median Arcuate Ligament Syndrome Treated With a Stent and Transcatheter Arterial Embolization: Preprocedural 4-Dimensional Computed Tomography Angiography Assessment

2021 ◽  
pp. 153857442110287
Author(s):  
Atsushi Saiga ◽  
Jun Koizumi ◽  
Koji Osumi ◽  
Joji Ota ◽  
Yoshihiro Kubota ◽  
...  
Keyword(s):  
False Lumen ◽  
Celiac Artery ◽  
Celiac Axis ◽  
Artery Dissection ◽  
True Lumen ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Retroperitoneal Hemorrhage ◽  
Celiac Axis Stenosis ◽  
Arcuate Ligament

A 61-year-old man presented with retroperitoneal hemorrhage caused by an aneurysm rupture of the pancreaticoduodenal arcade (PDA), and acute celiac artery dissection distal to celiac axis stenosis. Owing to the gradual growth of the false lumen, we planned to deploy a stent to the celiac artery dissection and embolize the PDA aneurysm. Prior to stent placement, we assessed the acute celiac artery dissection distal to the stenosis using four-dimensional computed tomography (CT) angiography through expiration/inspiration/expiration cycle. We diagnosed median arcuate ligament syndrome considering that the celiac axis showed a hooked narrowing at end-expiration, and the compression decreased at end-inspiration. Additionally, the true lumen distal to the stretched axis dilated in the inspiration phase. Therefore, we could advance a catheter into the true lumen during inspiration and successfully deploy a stent. Subsequently, laparoscopic median arcuate ligament release was performed after the stent deployment. A postoperative CT scan showed good patency in the stent, with disappearance of the blood filling the false lumen and with reduced celiac axis stenosis.

Median Arcuate Ligament Syndrome With Celiac Artery Aneurysm and Dissection

2020 ◽  
Vol 54 (6) ◽  
pp. 525-527
Author(s):  
Hans Michell ◽  
Nariman Nezami ◽  
Aaron Dewald ◽  
Anant Bhave ◽  
Christopher Morris ◽  
...  
Keyword(s):  
Artery Aneurysm ◽  
Celiac Artery ◽  
Artery Dissection ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament ◽  
Celiac Artery Aneurysm

Median arcuate ligament syndrome (MALS) is the chronic symptomatic compression of the celiac artery by the median arcuate ligament. A known potential sequela of MALS is celiac artery aneurysm, which could predispose the diseased artery to dissection. However, the presence of celiac artery dissection and MALS is yet to be reported. Here, we present a case of MALS with a coincident celiac artery aneurysm and dissection.

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.  

scholarly journals Laparoscopic treatment in a patient with median arcuate ligament syndrome identified at the onset of superior mesenteric artery dissection: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Haruhiko Okada ◽  
Kazuhisa Ehara ◽  
Hisashi Ro ◽  
Masaki Yamada ◽  
Tetsuya Saito ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Intraoperative Complications ◽  
Laparoscopic Approach ◽  
Celiac Axis ◽  
Artery Dissection ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Extrinsic Compression ◽  
Arcuate Ligament

Abstract Background Median arcuate ligament syndrome (MALS) is a rare clinical entity caused mainly by extrinsic compression of the celiac axis by the median arcuate ligament (MAL). Severe celiac artery stenosis can lead to the development of collateral circulation, aneurysms, and, rarely, superior mesenteric artery (SMA) dissection. The treatment of MALS involves the surgical release of the MAL. However, a standard procedure with the use of laparoscopy has not been established, and intraoperative complications can lead to severe vascular injury. Case presentation The patient was a 43-year-old man with MALS identified at the onset of SMA dissection. After treatment for the SMA dissection, he underwent laparoscopic MAL release. Using the technique of laparoscopic gastrectomy within the surgical field, we performed laparoscopic MAL release and ganglionectomy safely with a good view. Immediate symptomatic improvement was acquired, and no recurrence was observed at the 20-month follow-up. Conclusion We reported a rare case of MALS and SMA dissection. A horizontal 3D laparoscopic approach of the celiac axis allows for safe, meticulous, and radical MAL release and ganglionectomy.

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 Multiple Aneurysms of the Inferior Pancreaticoduodenal Artery: A Rare Complication of Acute Pancreatitis

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Chris Klonaris ◽  
Emmanouil Psathas ◽  
Athanasios Katsargyris ◽  
Stella Lioudaki ◽  
Achilleas Chatziioannou ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Rare Complication ◽  
Celiac Trunk ◽  
Celiac Artery ◽  
Median Arcuate Ligament ◽  
Pancreaticoduodenal Artery ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament ◽  
History Of ◽  
Technical Considerations

Inferior pancreaticoduodenal artery (IPDA) aneurysms are uncommon, representing nearly 2% of all visceral aneurysms, and sporadically associated with celiac artery stenosis. Multiple IPDA aneurysms have been rarely reported. We report a case of a 53-year-old female patient with a history of prior pancreatitis, who presented with two IPDA aneurysms combined with median arcuate ligament-syndrome-like stenosis of the celiac trunk. The patient was treated successfully with coil embolization under local anesthesia. The procedure is described and illustrated in detail and the advantages and technical considerations of such an approach are also being discussed.

scholarly journals Interprofessional Management of Median Arcuate Ligament Syndrome (Dunbar Syndrome) Related to Lumbar Lordosis and Hip Dysplasia: A Patient’s Perspective

2020 ◽  
Author(s):  
Sclinda Lea Janssen ◽  
Thomas Scholbach ◽  
Susan Jeno ◽  
Holte Laurie ◽  
Mandy Meyer ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Hip Dysplasia ◽  
Management Strategies ◽  
Celiac Artery ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Celiac Artery Compression Syndrome ◽  
Compression Syndrome ◽  
Arcuate Ligament ◽  
Dunbar Syndrome

We present a 53-year-old female patient with median arcuate ligament syndrome (MALS), also known as Dunbar syndrome or celiac artery compression syndrome, related to lumbar lordosis and hip dysplasia. She utilized interprofessional management strategies, which were beneficial in reducing lumbar lordosis and MALS-related symptoms. This finding is important because there are no other reports in the literature describing interprofessional strategies to manage symptoms for patients who are waiting for surgery or are not candidates for surgery.

scholarly journals A dangerous surgical masquerade - medial arcuate ligament syndrome as acute coronary syndrome: a case report

2020 ◽  
Vol 7 (6) ◽  
pp. 2016
Author(s):  
Preethi Subramanian ◽  
Rajan Vaithianathan
Keyword(s):  
Weight Loss ◽  
Case Report ◽  
Chest Pain ◽  
Celiac Artery ◽  
Sudden Onset ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Coronary Syndrome ◽  
Arcuate Ligament ◽  
Focal Stenosis

Median arcuate ligament syndrome is an uncommon cause for abdominal pain and weight loss, caused by median arcuate ligament compressing the celiac plexus or artery. Median arcuate ligament is the continuation of the posterior diaphragm which passes superior to celiac artery and surrounds the aorta. In this case report, A 67 year old male presented with complaints of sudden onset chest pain and loss of weight for the past 6 months. CECT thorax and abdomen it showed features of focal stenosis of coeliac axis and post stenotic dilation of the coeliac trunk suggesting median arcuate ligament syndrome. Laparoscopic median arcuate ligament release was done to relieve the patient from symptoms. Diagnosis of median arcuate ligament syndrome should be considered in a patient presenting with chest pain and weight loss with normal cardiac status and unexplained etiology.

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