title: Median Arcuate Ligament Syndrome: A Single-Center Experience with 23 Patients.
abstract: BACKGROUND
  Median arcuate ligament syndrome (MALS) is a rare entity that occurs when the median arcuate ligament of the diaphragm is low-lying, causing a compression to the underlying celiac trunk. We reviewed the vascular changes associated with MALS in an effort to emphasize the seriousness of this disease and the complications that may result.
  
  
  METHODS
  This is a retrospective descriptive analysis of 23 consecutive patients diagnosed with MALS between January 1, 2012 and December 31, 2015 at a tertiary medical center. Computed tomographic (CT) scans, medical records, and patient follow-up were reviewed.
  
  
  RESULTS
  The number of patients included herein was 23. The median age was 56 years (17-83). Sixteen patients (69.6%) had a significant arterial collateral circulation. Eleven patients (47.8%) were found to have visceral artery aneurysms; 4 patients (36.4%) bled secondary to aneurysm rupture. All ruptured aneurysms were treated with endovascular approach. The severity of the hemodynamic changes appears to be greater with complete occlusion, CONCLUSIONS: MALS causes pathological hemodynamic changes within the abdominal vasculature. Follow-up is advised for patients who develop a collateral circulation. Resulting aneurysms should preferably be treated when the size ratio approaches three. Treatment of these aneurysms can be done via an endovascular approach coupled with possible celiac artery decompression to restore physiologic blood flow.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, American University of Beirut Medical Center, Cairo St. Hamra, Beirut, Lebanon.
authors.forename: Layla A
authors.initials: LA
authors.lastname: Nasr
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Cairo St. Hamra, Beirut, Lebanon.
authors.forename: Walid G
authors.initials: WG
authors.lastname: Faraj
authors.affiliation: Division of Interventional Radiology, Department of Radiology, American University of Beirut Medical Center, Cairo St. Hamra, Beirut, Lebanon.
authors.forename: Aghiad
authors.initials: A
authors.lastname: Al-Kutoubi
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Imperial College-London Faculty of Medicine, London, SW7 2AZ, UK.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Hamady
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Cairo St. Hamra, Beirut, Lebanon.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Khalifeh
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Cairo St. Hamra, Beirut, Lebanon.
authors.forename: Ali
authors.initials: A
authors.lastname: Hallal
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Cairo St. Hamra, Beirut, Lebanon.
authors.forename: Hamzeh M
authors.initials: HM
authors.lastname: Halawani
authors.affiliation: Division of Interventional Radiology, Department of Radiology, American University of Beirut Medical Center, Cairo St. Hamra, Beirut, Lebanon.
authors.forename: Joelle
authors.initials: J
authors.lastname: Wazen
authors.affiliation: Division of Interventional Radiology, Department of Radiology, American University of Beirut Medical Center, Cairo St. Hamra, Beirut, Lebanon. ah24@aub.edu.lb.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Haydar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging* / Q000628:therapy; D002445:Celiac Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D003097:Collateral Circulation; D003251:Constriction, Pathologic / Q000150:complications* / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D000074742:Median Arcuate Ligament Syndrome; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Embolization; Median arcuate ligament; Visceral aneurysms