IP243 Outcomes of Celiac Decompression in a Cohort of Patients With Median Arcuate Ligament Syndrome

Abstract

Median arcuate ligament syndrome (MALS) is a rare clinical entity characterized by postprandial abdominal pain, nausea, vomiting, and weight loss. Timely diagnosis and optimal management remain challenging in contemporary vascular practice, and treatment delays are often the norm. The purpose of our study was to review our experience with celiac decompression for MALS. All patients undergoing celiac decompression for MALS between July 2013 and December 2016 were retrospectively reviewed. Patient demographics, clinical data, and outcomes (length of stay, morbidity and clinical response) were collected. Clinical response was assessed during follow-up visits using a quality of life questionnaire. At our institution, a dynamic computed tomography angiography (CTA) protocol with inspiratory and expiratory pressure gradient measurements was developed to assess these patients. Over the study period, 25 patients (80% female) underwent celiac decompression for MALS (one laparoscopically). Four patients underwent aortoceliac bypass in addition to celiac decompression. The mean age was 47.4 ± 20.1 years. The mean body mass index was 25.5 ± 7.5 kg/m2, and mean weight loss at presentation was 20.3 ± 36.2 pounds. The mean time from symptoms to diagnosis was 28.3 ± 30.1 months. Diagnostic imaging used prior to referral to us most commonly involved mesenteric ultrasound (16%), magnetic resonance angiography (4%), angiography (8%), and nondynamic CTA (64%). The mean degree of celiac artery stenosis on dynamic CTA was 73.7% ± 23.8%. Seventeen patients (68%) had celiac plexus block prior to definitive intervention. No in-hospital morbidity or mortality occurred in this cohort. Follow-up data were available for all patients for a median of 4.3 months (range, 1-90 months). The freedom from symptoms was 92%, and freedom from reintervention was 100%. All patients reported excellent or good response to surgery with improvements in their quality of life and weight gain. An institutional protocol of dynamic CTA has greatly expedited diagnosis and treatment plans for patients with suspected MALS. In this longitudinal evaluation, celiac decompression, with or without bypass, was associated with symptomatic relief and improvements in quality of life. Further prospective evaluation of these results is warranted.