scholarly journals McKeown esophagectomy with concomitant median arcuate ligament release in a case of esophageal cancer with celiac artery stenosis

2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Keita Hanada ◽  
Shigeru Tsunoda ◽  
Satoshi Ogiso ◽  
Tatsuto Nishigori ◽  
Shigeo Hisamori ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Gastric Tube ◽  
Celiac Artery ◽  
Artery Stenosis ◽  
Median Arcuate Ligament ◽  
Collateral Arteries ◽  
Abdominal Symptoms ◽  
Patient Reported ◽  
Arcuate Ligament ◽  
Mckeown Esophagectomy

Abstract Background The celiac artery stenosis due to compression by median arcuate ligament (MAL) has been reported in many cases of pancreaticoduodenectomy, but not in cases of esophagectomy. Recently, the celiac artery stenosis due to MAL or arteriosclerosis has been reported to be associated with the gastric tube necrosis or anastomotic leakage following Ivor–Lewis esophagectomy. Herein, we present the first reported case of esophageal cancer with celiac artery stenosis due to compression by the MAL successfully treated by McKeown esophagectomy and gastric tube reconstruction following prophylactic MAL release. Case presentation A 72-year-old female patient was referred to our department for esophagectomy. The patient had received two courses of neoadjuvant chemotherapy with 5-FU and cisplatin for T2N0M0 squamous cell carcinoma of the middle esophagus. Preoperative contrast-enhanced computed tomography (CECT) showed celiac artery stenosis due to compression by the MAL. The development of collateral arteries around the pancreatic head was observed without evidence of aneurysm formation. The patient reported no abdominal symptoms. After robot-assisted esophagectomy with mediastinal lymphadenectomy, gastric mobilization, supra-pancreatic lymphadenectomy, and preparation of the gastric tube were performed under laparotomy. Subsequently, the MAL was cut, and released to expose the celiac artery. Improved celiac artery blood flow was confirmed by decreased pulsatility index on intraoperative Doppler sonography. The operation was completed with the cervical esophagogastric anastomosis following cervical lymphadenectomy. Postoperative CECT on postoperative day 7 demonstrated increased celiac artery patency. The patient had an uncomplicated postoperative course thereafter. Conclusions Prophylactic MAL release may be considered in patients with celiac artery stenosis due to compression by the MAL on preoperative CECT for esophagectomy.

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.

Image Findings in Celiac Artery Stenosis Due to Median Arcuate Ligament Compression

2014 ◽  
Vol 18 (3) ◽  
pp. 638-640 ◽  
Author(s):  
Keli M. Turner ◽  
Kunmi Majekodunmi ◽  
Alif Manejwala ◽  
David Neschis ◽  
Zina Novak ◽  
...  
Keyword(s):  
Celiac Artery ◽  
Artery Stenosis ◽  
Median Arcuate Ligament ◽  
Arcuate Ligament

Celiac Artery Stenosis due to Median Arcuate Ligament Compression: A Risk Factor in Pancreaticoduodenectomy?

2015 ◽  
Vol 93 (8) ◽  
pp. 541-543
Author(s):  
Izaskun del Hoyo Aretxabala ◽  
Pilar Gómez García ◽  
M. Inmaculada Concepción Cruz González ◽  
Sandra Ruiz Carballo ◽  
Iñaki Iturburu Belmonte
Keyword(s):  
Risk Factor ◽  
Celiac Artery ◽  
Artery Stenosis ◽  
Median Arcuate Ligament ◽  
Arcuate Ligament

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.

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.

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