Celiac Artery Compression Syndrome Research Articles

Celiac Artery Compression Syndrome in an Adolescent Male

Celiac Artery Compression Syndrome in an Adolescent Male

Laparoscopic repair of iatrogenic celiac artery injury during median arcuate ligament release: A retrospection and tips at troubleshooting.

Median arcuate ligament (MAL) syndrome or celiac artery (CA) compression syndrome previously treated mainly by vascular surgeons using the open approach is now being increasingly performed by general surgeons with training in advanced laparoscopy. Although this approach has all the advantages of minimal access surgery, the procedure is fraught with serious complications like injury to major vascular structures during dissection. Vascular injury by far is the major cause of conversion to open procedure. Herein, we report a laparoscopic repair of iatrogenic CA injury by intra-corporeal suturing during MAL release. We also elaborate the causes, the preventive measures that can be applied to avoid such catastrophic occurrences in future. To the best of our knowledge, this is the first report of a laparoscopic repair of CA bleed during MAL release.

Ultrasound characteristics of abdominal vascular compression syndromes.

Abdominal vascular compression syndrome (AVCS) is caused by the compression of abdominal blood vessels by adjacent structures or the compression of abdominal organs by neighboring blood vessels. Such compressions can result in a variety of clinical symptoms. They are not commonly seen in ultrasound practices, and their presence may have been underrecognized and underdiagnosed. This article reviews the clinical features, ultrasound characteristics, and diagnostic criteria of four types of AVCS, namely, celiac artery compression syndrome, renal vein compression syndrome, iliac vein compression syndrome, and superior mesenteric artery syndrome to increase awareness of these conditions among ultrasound practitioners. The ultrasound criteria for AVCS are primarily based on studies with small sample sizes, and therefore, it is important to exercise caution if these criteria are used.

S4084 Celiac Artery Compression Syndrome: A Rare Diagnosis for a Common Complaint

S4084 Celiac Artery Compression Syndrome: A Rare Diagnosis for a Common Complaint

Multiple pancreaticoduodenal artery aneurysms and retroperitoneal bleeding in a patient with celiac artery compression syndrome.

Multiple pancreaticoduodenal artery aneurysms and retroperitoneal bleeding in a patient with celiac artery compression syndrome.

The Association Between Corrective Surgery for Adult Spinal Deformity and Serum Levels of Hepatobiliary Enzymes.

Background and objective The surgery to correct adult spinal deformity (ASD) is associated with a rare, but life-threatening complication called acute celiac artery compression syndrome (ACACS). To our knowledge, there is currently no study in the literature regarding the abnormal elevation of serum levels of hepatobiliary enzymes after surgery to correct the deformity. In light of this, the purpose of this study was to investigate this potential association. Materials and methods We collected data on 74 patients with ASD who underwent correction surgery at our institution. A Spearman's rank-order correlation was used to assess the association between serum levels of hepatobiliary enzymes and spinal parameters. Factors showing a correlation coefficient of 0.2 or more were combined in a stepwise multiple regression analysis. Results The mean age of the patientswas 68.4 ± 7.7 years; the study comprisedsix men and 68 women. In our stepwise multiple regression analysis, there were two valid models that included spinal parameters as independent variables: changes in lactate dehydrogenase (LDH) - changes in thoracolumbar kyphosis (TLK) (B -0.0025 ± 0.0007, p<0.01), and changes in LDH - preoperative T12-L1 kyphosis (B 0.0031 ± 0.001, p<0.01). Additionally, both valid models contained median arcuate ligament (MAL) overlap defined as MAL crossing the base of the celiac artery (CA) as a significant independent variable. Conclusions Greater sagittal correction of TLK, larger preoperative T12-L1 kyphosis, and MAL overlap were factors associated with an elevated serum level of LDH. Although few patients werereported to have clinically severe symptoms, "potential" ACACS due to a temporary blood flow disturbance can occur in this patient population.

Analysis of the relationship between spinal alignment and retrocrural space area in adult spinal deformity surgery: Potential risk factors for acute celiac artery compression syndrome

PurposeThis study was designed to reveal the association between spinal parameters and RCS area in patients with adult spinal deformities treated with spinal correction surgery. We hypothesized that reduction of the retrocrural space (RCS) area is related to thoracolumbar alignment, which may cause acute celiac artery compression syndrome (ACACS). MethodsEighty-nine patients (age: 68.4 ± 7.6 years; sex: 7 male/82 female) with ASD treated by spinal correction surgery were enrolled. Preoperative and postoperative spinal parameters were measured, and the differences between these parameters were calculated. Postoperative T12 translation was measured and RCS area was evaluated using reconstructed computed tomography. The change of RCS area after surgery was defined as ΔRCS. Patients were divided into increased and decreased RCS groups by the ΔRCS value, and spinal parameters were compared between groups. The correlation between spinal parameters and ΔRCS was calculated. ResultsThe patients in the decreased RCS group had greater anterior T12 translation than those in the increased RCS group (p < 0.001). T12 translation was significantly correlated with ΔRCS (β = −0.31, p = 0.017). There were no correlations between ΔRCS and other spinal parameters. ConclusionThoracolumbar alignment was associated with RCS area. Consistent with the hypothesis, overcorrection of the thoracolumbar junction was associated with reduced RCS area and might be one risk factor for ACACS.

The anatomical relationship between the celiac artery and the median arch ligament in degenerative spinal surgery

BackgroundThis study aimed to characterize the anatomical relationship between the spine, the celiac artery (CA), and the median arcuate ligament using preoperative contrast-enhanced computed tomography (CT) images of patients with spinal deformity who underwent surgical correction. MethodsThis retrospective study included 81 consecutive patients (34 males, 47 females; average age: 70.2 years). The spinal level at which the CA originated, the diameter, extent of stenosis, and calcification were determined using CT sagittal images. Patients were divided into two groups: CA stenosis group and non-stenosis group. Factors associated with stenosis were examined. ResultsCA stenosis was observed in 17 (21%) patients. CA stenosis group had significantly higher body mass index (24.9 ± 3.9 vs. 22.7 ± 3.7, p = 0.03). In the CA stenosis group, J-type CA (upward angling of the course by more than 90° immediately after descending) was more frequently observed (64.7% vs. 18.8%, p < 0.001). The CA stenosis group had lower pelvic tilt (18.6 ± 6.7 vs. 25.1 ± 9.9, p = 0.02) than non-stenosis group. ConclusionsHigh BMI, J-type, and shorter distance between CA and MAL were risk factors for CA stenosis in this study. Patients with high BMI undergoing fixation of multiple intervertebral corrective fusions at the thoracolumbar junction should undergo preoperative CT evaluation of the anatomy of CA to assess the poteitial risk of celiac artery compression syndrome.

A rare case of celiac artery compression syndrome

It is uncommon for children to have celiac artery compression syndrome. We describe a case of celiac artery compression syndrome in a young child who initially reported to us with severe recurrent epigastric pain abdomen and nausea. Historical evidence of rapid weight loss over 15 days. When the child's symptoms persisted despite symptomatic treatment, comprehensive testing revealed that the child had celiac artery compression syndrome. In this report, we emphasize the significance of taking celiac artery compression syndrome into account as one of the differential diagnoses for acute severe epigastric pain that is unresponsive to standard gastritis treatment and when all investigations for pancreatitis, ureteric obstruction, and renal colic are normal.

A rare case of celiac artery compression syndrome

A rare case of celiac artery compression syndrome

A rare case of celiac artery compression syndrome

A rare case of celiac artery compression syndrome

Risk factors for celiac artery and superior mesenteric artery stenosis in preoperative lumbar and thoracolumbar spinal surgery patients

BackgroundIschemic necrosis of the abdominal organs caused by compression of the celiac artery (CA) and superior mesenteric artery (SMA) by the median arcuate ligament (MAL) after correction surgery has been recognized as acute celiac artery compression syndrome (ACACS). Here, using contrast-enhanced computed tomographic (CT) images, we sought to determine the prevalence and degree of CA and SMA stenosis in spinal patients preoperatively, and the risk factors associated with the stenosis. MethodsWe retrospectively examined contrast-enhanced abdominal CT of 90 patients with preoperative lumbar degenerative disease, lumbar burst fracture, or adult spinal deformity. The trunks of the CA and SMA were detected using three-dimensional reconstructed CT. To investigate their degree of stenosis, we determined the ratio of the narrowest diameter of the stenotic segment to the distal normal lumen's diameter. Patients with a degree of stenosis ≥35% were defined as being in the group with stenosis and the remainder as in the group without. To determine the risk factors for stenosis of these arteries, the relationship between the stenosis and CA and SMA calcification or the median arcuate ligament (MAL) crossing the proximal portion of the celiac axis (MAL overlap) was also investigated. ResultsThe average degree of stenosis of the CA trunk was 12.1% ± 13.9% and that for the SMA trunk was 8.5% ± 8.8%. There were 8 patients (8.9%) in the group with CA stenosis and 2 patients (2.2%) in the group with SMA stenosis. The number of patients in the group with CA stenosis was significantly greater than the number with MAL overlap or CA calcification (P < 0.05). DiscussionThe prevalence of CA or SMA stenosis was 11.2% of preoperative patients due to undergo thoracolumbar fusion surgery. Calcifications of the CA trunk and MAL overlap are risk factors for CA stenosis.

Celiac artery compression syndrome in children

The manifestation of celiac artery compression syndrome in childhood is rarely described. At the same time, celiac artery compression syndrome remains one of the most discussed vascular diseases due to an unclear pathophysiological mechanism, difficulties in differential diagnosis, and the lack of a generally accepted algorithm for treating patients. In connection with the above, it seems relevant to analyze the features of managing children with celiac artery compression syndrome. As a result of the analysis of the scientific literature, we have come to the following conclusions: 1. Typical clinical characteristics of celiac artery compression syndrome include abdominal pain, epigastric murmur and weight loss associated with compression of the celiac artery and possibly celiac ganglia by the median arcuate ligament. 2. CT angiography and conventional catheter angiography are the gold standard for diagnosis. However, imaging findings should not be interpreted in isolation from clinical manifestations. 3. Surgical decompression of the celiac artery by resection of the median arcuate ligament is the treatment of choice for this syndrome. Both open surgery and laparoscopic techniques are safely performed with minimal morbidity and mortality. Endovascular treatment of compression celiac stenosis may have limited success.

Clinic, diagnosis and treatment of dunbar syndrome in children

Aim: To determine the clinical, diagnostic and therapeutic features of Dunbar syndrome in children. Methods: Scientific work was carried out based on the "Republican Children's Clinical Hospital" and the "City Children's Clinical Hospital", Cheboksary. The basis of this study was a survey of 200 children with celiac artery compression syndrome. The results obtained in the course of the work were analyzed on the basis of the Department of Children's Diseases of the I.N. Ulianov Chuvash State University. In addition to routine diagnostic methods, Instrumental methods have been adopted: ultrasound Doppler scanning (Hitachi Vision Avius, Japan), CT angiography (SOMATOM Emotion, SIEMENS (China), Revolution EVO, GE (Russia)) and Magnetic resonance angiography (Optima MR450w 1.5, USA). The duration of the study is short (after surgery) and long-term (up to 2 years). Results: Dunbar syndrome is more often observed in girls, which in 75% of cases is accompanied by signs of chronic abdominal ischemia. Significant and prolonged stenosis of the celiac artery can cause the development of a number of complications (pancreatic-duodenal artery aneurysms, etc.).

A nationwide analysis of median arcuate ligament release between 2010 and 2020: a NSQIP Study.

BackgroundMedian arcuate ligament syndrome is a rare disease with overlapping symptoms of broad foregut pathology. Appropriately selected patients can benefit from a laparoscopic or open median arcuate ligament release. Institutional series have reported the outcomes of open and laparoscopic techniques but there are no nationwide analysis comparing both techniques and overall trends in treatment.MethodsCross-sectional study using the American College of Surgeons-National Surgical Quality Improvement Project from 2010 to 2020. Celiac artery compression syndrome cases were identified by International Classification of Diseases (ICD) codes and categorized as open or laparoscopic. Trends in the use of each technique and 30-day complications were compared between the groups.ResultsA total of 578 open cases (76%) and 185 laparoscopic cases (24%) were identified. There was an increase adoption of the laparoscopic approach, with 22% of the cases employing this technique at the end of the study period, compared to 7% at the beginning of the study period. The open group had a higher prevalence of hypertension (26% vs 18%, p = 0.04) and bleeding disorders (5% vs 2%, p 0.03). Laparoscopic approach had a shorter length of stay (2.3 days vs 5.2 days, p < 0.0001), lower major complication rates (0.5% vs 4.0%, p = 0.02) and lower reoperation rates (0% vs 2.6%, p = 0.03). Overall mortality was 0.1%.ConclusionOverall numbers of surgical intervention for treatment of median arcuate ligament increased during this timeframe, as well as increased utilization of the laparoscopic approach. It appears to be an overall safe procedure, offering lower rates of complications and shorter length of stay.

Celiac Artery Compression Syndrome: An Overlooked Cause of Abdominal Pain.

Celiac Artery Compression Syndrome: An Overlooked Cause of Abdominal Pain.

Median arcuate ligament syndrome

Chronic abdominal pain has several aetiologies, and many a times, the aetiology is one of the exclusions. Median arcuate ligament syndrome (MALS) also called coeliac artery compression syndrome is a form of chronic mesenteric ischaemia, although rare is an important cause. A 20-year-old male presented with recurrent episodes of pain abdomen, with a history of multiple admissions for the same, before the surgery. His physical examination and laboratories were normal, but the computed tomography (CT) done initially gave a doubtful diagnosis of MALS. A CT angiogram was done, which showed a definite kinking of the coeliac axis. After all the other causes of abdominal pain were ruled out, the patient was taken up for surgery with a provisional diagnosis of MALS. Intraoperatively, there was fibrosis around the coeliac axis with kinking. The fibrosis was cleared, and pulsations of the artery were confirmed. Postoperatively, the patient had an uneventful recovery.

Median arcuate ligament syndrome – Current state of management

Symptomatic celiac artery compression syndrome (CACS) or median arcuate ligament syndrome (MALS) is a controversial diagnosis that should be considered in patients with chronic abdominal pain of unknown etiology despite an extensive medical evaluation. Once suspected, patients should undergo mesenteric duplex ultrasound. Diagnosis is confirmed with elevated celiac artery velocities which normalize with deep inspiration followed by CT angiogram showing the typical “J-hook” conformation of the celiac artery. Patients should then undergo evaluation by a multi-disciplinary team to appropriately select and prepare patients for potential surgical treatment. Surgical options include release of the median arcuate ligament, with or without neurolysis of the celiac nerve plexus, and with or without concomitant revascularization procedures. Approaches can be open, laparoscopic, or robotic. Surgical treatment has an overall success rate of 70-80% with patients reporting improved abdominal pain and quality of life. Post-operatively, patients can have persistent or recurrent abdominal pain and should undergo re-evaluation for possible need for a revascularization procedure for stenosis of the celiac artery or celiac plexus block if the celiac artery flow is normalized. Additionally, some patients will have persistent pain consistent with functional gastrointestinal disorder (FGID) that will then require medical management. Psychiatric comorbidities have been identified as a predisposing factor that may predict poorer outcomes, and there are preliminary findings suggesting that patients with dysautonomia diagnoses may have worse outcomes as well.

Laparoscopic dissection in children with celiac artery compression syndrome

BACKGROUND: A cause of abdominal pain in children may be compression stenosis of the celiac trunk (Dunbars syndrome). This disease occurs when the median arcuate ligament of the diaphragm compresses the celiac trunk, thereby creating compression stenosis, causing the arterial hemodynamics in the artery to suffer and provide adequate blood circulation to the abdominal cavity organs. Medical statistics indicate that 10% to 15% of children and adolescents suffering from chronic abdominal pain have compression stenosis of the celiac trunk.&#x0D; AIM: This study aims to improve the diagnostic results and identify the indications for the surgical treatment of children with compression stenosis of the celiac trunk.&#x0D; MATERIALS AND METHODS: From 2015 to 2020 at the N.F. Filatov Childrens Hospital, 64 patients, aged 4 to 17 years underwent surgical treatment for compression stenosis of the celiac trunk. There are 42 boys (66%) and 22 girls (34%). The leading clinical manifestation in all patients was abdominal pain. Associated surgical pathology was observed in 34 of them. The diagnosis was based on anamnesis, examination, ultrasound examination with Doppler and celiac trunk blood flow measurements, multispiral computed tomography, and angiography.&#x0D; RESULTS: After completing the examination, 61 patients underwent laparoscopic decompression of the celiac trunk, and three children were operated on using the laparotomic approach. In all cases, the leading cause of compression stenosis of the celiac trunk was the median arcuate ligament of the diaphragm combined with the neurofibrous tissue of the celiac plexus. The average duration of the operation was 50 minutes. Intraoperative blood loss did not exceed 530 ml. One conversion completed. There were no postoperative complications in the early postoperative period. The patients were discharged in satisfactory condition. The control examination was conducted in the period from six months to three years. In 97% of patients, clinical symptoms of abdominal ischemia were not detected.&#x0D; CONCLUSION: Our experience indicates the possibility of diagnosing compression stenosis of the celiac trunk in children at early disease stages and laparoscopic treatment success of patients with this disease.

Median Arcuate Ligament Syndrome Clinical Presentation, Pathophysiology, and Management: Description of Four Cases

Median arcuate ligament syndrome (MALS), otherwise called celiac artery compression syndrome (CACS), is an uncommon disorder that results from an anatomical compression of the celiac axis and/or celiac ganglion by the MAL. Patients typically present with abdominal pain of unknown etiology exacerbated by eating along with nausea, vomiting, and weight loss. MALS is a diagnosis of exclusion that should be considered in patients with severe upper abdominal pain, which does not correlate with the objective findings. The cardinal feature which is elicited in the diagnosis of MALS relies on imaging studies of the celiac artery, demonstrating narrowing during expiration. The definitive treatment is the median arcuate ligament’s surgical release to achieve surgical decompression of the celiac plexus by division of the MAL. This article describes our experience with this entity, focusing on symptom presentation, diagnostic challenges, and management, including long-term follow-up in four cases.