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Celiac Artery Decompression for Median Arcuate Ligament Syndrome: A Single Center Experience
Alec Rezigh, BS1, Rana O. Afifi, MD1, Sapan S. Desai, MD2, Kristofer M. Charlton-Ouw, MD1, Naveed U. Saqib, MD1, Charles C. Miller, PhD1, Anthony L. Estrera, MD1, Hazim J. Safi, MD1, Ali Azizzadeh, MD1.
1The University of Texas at Houston Medical School, Houston, TX, USA, 2Southern Illinois University School of Medicine, Springfield, IL, USA.
Objectives:
Median Arcuate Ligament Syndrome (MALS) results from celiac artery compression by the median arcuate ligament and is most often associated with chronic abdominal pain. A recent National Inpatient Sample (NIS) study has shown that only 2.4% of patients with MALS undergo celiac artery decompression (CAD). The objective of this study was to evaluate the outcomes of MALS after CAD.
Methods:
We collected retrospective data on patients diagnosed with MALS who underwent CAD at our institution. All patients underwent evaluation by a gastroenterologist to rule out other pathology. All patients diagnosed with MALS underwent open CAD through a midline incision. Patients completed a postoperative questionnaire used to evaluate specific MALS related symptoms and their improvement after CAD.
Results:
Between 2009 and 2014, we treated 8 patients (5 female, mean age, 58.8 years) with MALS by open CAD. Abdominal pain was the primary clinical symptom (n=8;100%), followed by nausea and weight loss (n=4;50% for both). Angiography (inspiration and expiration) was the most utilized imaging modality (n=7, 88%) followed by computed tomography (CT) (n=6, 75%), magnetic resonance imaging (n=3, 38%) and ultrasound (n=1, 13%). There were no immediate intraoperative or postoperative complications. All 8 patients reported improvement in abdominal pain and corresponding symptoms based on the questionnaire. Two patients with residual symptoms underwent post-operative revascularization, one receiving celiac artery percutaneous transluminal angioplasty (PTA) and the other celiac PTA and stenting (25%). The patients who required postoperative revascularization had documented preoperative celiac artery stenosis or dissection. The median follow-up time was 7.5 months (range 1 to 63 months).
Conclusion:
Open CAD appears to be a safe and effective treatment modality for MALS. Patients with intraluminal lesions (dissection or stenosis) may require additional revascularization.
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