scholarly journals Supra-Arcuate Ligament Blocks: Anatomy, Mechanisms, and Techniques

2021 ◽  
Vol Volume 14 ◽  
pp. 3837-3848
Author(s):  
Huili Li ◽  
Jinghan Liang ◽  
Peiqi Shao ◽  
Junwei Zheng ◽  
Rong Shi ◽  
...  
Keyword(s):  
2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110199
Author(s):  
Young Hoon Sul ◽  
Yook Kim

Transcatheter arterial embolization (TAE) is the standard of care for haemodynamically-stable patients with blunt hepatic injury but it is sometimes impossible due to unfavourable vascular anatomies. This case report describes a 43-year-old male patient with abdominal pain following a motorcycle accident. Based on computed tomography (CT) findings, he was diagnosed with high-grade hepatic injury with coeliac axis stenosis (CAS) due to compression by the median arcuate ligament, and an aberrant right hepatic artery. Contrast-enhanced ultrasonography (CEUS) demonstrated multiple high echogenic tubular and ovoid structures suggestive of active bleeding within the injured liver area. Angiography revealed unique interlobar and intrahepatic collateral vessels between the right and left hepatic arteries. Liver haemorrhages were also identified. Catheterization of the feeding arteries through the collateral pathway was unsuccessful, so a decision was made to cannulate the stenotic portion of the coeliac trunk with a 5-Fr Yashiro catheter. After several attempts, the microcatheter was successfully advanced coaxially into the common hepatic artery. Embolization was performed with a 1:2 mixture of N-butyl cyanoacrylate and iodized oil. Successful haemostasis was confirmed following TAE. CEUS helped clinicians identify active bleeding following traumatic solid organ injury. TAE was a safe and effective treatment strategy. Before performing TAE, attention should be given to the presence of CAS associated with compression by the median arcuate ligament.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hiroshi Saito ◽  
Koichiro Sawada ◽  
Jyunichi Ogawa ◽  
Masashi Hashimoto ◽  
Masahiro Oshima ◽  
...  

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.


Author(s):  
Kyoji Ito ◽  
Nobuyuki Takemura ◽  
Ryo Oikawa ◽  
Fuyuki Inagaki ◽  
Fuminori Mihara ◽  
...  

1999 ◽  
Vol 7 (6) ◽  
pp. E11 ◽  
Author(s):  
Srinath Samudrala ◽  
Larry T. Khoo ◽  
Seung C. Rhim ◽  
Richard G. Fessler

Procedures involving anterior surgical decompression and fusion are being performed with increasing frequency for the treatment of a variety of pathological processes of the spine including trauma, deformity, infection, degenerative disease, failed-back syndrome, discogenic pain, metastases, and primary spinal neoplasms. Because these operations involve anatomy that is often unfamiliar to many neurological and orthopedic surgeons, a significant proportion of the associated complications are not related to the actual decompressive or fusion procedure but instead to the actual exposure itself. To understand the nature of these injuries, a detailed anatomical study and dissection was undertaken in six cadaveric specimens. Critical structures at risk in the abdomen and retroperitoneum were identified, and their anatomical relationships were categorized and photographed. These structures included the psoas muscle, kidneys, ureters, diaphragm and crura, esophageal hiatus, thoracic duct, greater splanchnic nerves, phrenic nerves, sympathetic chains, medial arcuate ligament, superior and inferior hypogastric plexus, segmental and radicular vertebral vessels, aorta, vena cava, median sacral artery, common iliac vessels, iliolumbar veins, lumbosacral plexus, and presacral hypogastric plexus. Based on these dissections and an extensive review of the literature, the authors provide a detailed anatomically based discussion of the complications associated with anterior lumbar surgery.


2018 ◽  
Vol 154 (6) ◽  
pp. S-1307
Author(s):  
Andrew T. Strong ◽  
Hana Fayazzadeh ◽  
John Rodriguez ◽  
Matthew Kroh ◽  
Woosup M. Park ◽  
...  

2017 ◽  
Vol 65 (6) ◽  
pp. 120S
Author(s):  
Bernardino C. Branco ◽  
Jayer Chung ◽  
Ramyar Gilani ◽  
Miguel Monter-Baker ◽  
Joseph Mills ◽  
...  

2016 ◽  
Vol 63 (6) ◽  
pp. 53S
Author(s):  
Jacquelenn Stuhldreher ◽  
Stephen Kavic ◽  
Michael P. Lilly ◽  
Mariano Arosemena

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