Eight years experience in the management of median arcuate ligament syndrome by decompression, celiac ganglion sympathectomy, and selective revascularization.
We aim to review an 8-year experience of median arcuate ligament syndrome (MALS) with chronic gastrointestinal ischemia (CGI) and evaluate clinical outcomes of arcuate ligament decompression, celiac sympathectomy, and selective revascularization. Between December 2002 and March 2012, of 25 patients referred with symptoms of CGI, 11 patients (10 women and 1 man) had clinical signs of abdominal angina and radiological evidence of MALS. Mean age was 50 ± 20.4 years. Median symptom duration was 34 months. All patients had median arcuate decompression and celiac sympathectomy. In all, 8 did not require revascularization, 2 had retrograde celiac and/or superior mesenteric artery (SMA) stenting, and 1 had SMA bypass. There was no mortality. The 30-day morbidity was 9%. Mean follow-up was 60 months. Eight patients noted complete relief of abdominal pain, and 1 reported some improvement. The MALS is not solely a vascular compression syndrome. The neurological component requires careful celiac plexus sympathectomy in addition to arcuate ligament decompression.
1Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland.
Sherif
S
Sultan
Niamh
N
Hynes
Naisrin
N
Elsafty
Wael
W
Tawfick
D000368:Aged; D000369:Aged, 80 and over; D002445:Celiac Artery / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D005728:Ganglia, Sympathetic / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D000074742:Median Arcuate Ligament Syndrome; D065666:Mesenteric Ischemia; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D015607:Stents; D013562:Sympathectomy / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation
celiac axis compression; celiac ganglion hyperstimulation; median arcuate ligament syndrome; mesenteric revascularization; surgical decompression