Celiac Artery Compression Syndrome Research Articles

A variant of the median arcuate ligament syndrome: are sagittal images enough for diagnosis?

Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is a rare cause of abdominal discomfort, postprandial pain and weight loss. Doppler ultrasonography (USG), computed tomography (CT), magnetic resonance imaging (MRI), and selective catheter angiography can be used to identify this abnormality. Classically, the "fish hook" appearance is seen on sagittal images. In our case, mild stenosis (20%) was seen at the origin of the celiac artery without typical "fish hook" appearance. Higher degree stenosis (55%) was demonstrated on axial images. We are presenting a rare case of a MALS caused by prominent crura.

Surgical treatment of Dunbar syndrome

Dunbar syndrome or celiac artery compression syndrome is an infrequently described clinical condition with poorly defined diagnostic criteria and an obscure pathophysiology. It is usually associated with an extrinsic compression upon the celiac axis near its takeoff from the aorta by fibrous diaphragmatic bands or sympathetic neural fibers. The authors report the case of a 70-year-old male patient presenting with nausea, epigastric pain, and weight loss. An aortography showed a compression of the celiac trunk. A preliminary attempt at percutaneous transluminal angioplasty and stenting proved unsuccessful. The patient became asymptomatic and his clinical condition improved after surgical release of the celiac trunk by partial section of the arcuate ligament of the diaphragm and with resection of the neural, fibrotic, and lymphatic tissues surrounding the aortic and visceral vessels. The purpose of this report is to discuss the indications and the therapeutic options of this syndrome.

Celiac Artery Compression Syndrome

Celiac artery compression syndrome is a rare disorder characterized by episodic abdominal pain and weight loss. It is the result of external compression of celiac artery by the median arcuate ligament. We present a case of celiac artery compression syndrome in a 57-year-old male with severe postprandial abdominal pain and 30-pound weight loss. The patient eventually responded well to surgical division of the median arcuate ligament by laparoscopy.

Diagnosis of Median Arcuate Ligament Syndrome on Multidetector Computed Tomography

The median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is a condition which develops secondary to an ischemia in gastrointestinal organs resulting from the compression of proximal celiac truncus by the median arcuate ligament of the diaphragm. It is characterized by postprandial abdominal pain or weight loss. The MALS is conventionally diagnosed by angiography; however, currently the condition can also be diagnosed with multidetector computed tomography (MDCT). In this paper, we aimed to present three cases that were diagnosed with median arcuate ligament syndrome on MDCT. J Med Cases. 2013;4(9):616-619 doi: http://dx.doi.org/10.4021/jmc1384w

Robotic‐assisted treatment of celiac artery compression syndrome: report of a case and review of the literature

The surgical management of celiac artery compression syndrome (CACS) is controversial. Controversies include the appropriate surgical technique, the surgical approach, and the utility of postoperative stents. The literature is reviewed, and a case of CACS is presented in which a robotic-assisted division of the median arcuate ligament (MAL) was performed. Robotic-assisted treatment of celiac artery syndrome was carried out using six (five 1 cm and one 2 cm) abdominal incisions. The robotic device was used to expose the aorta and celiac artery and divide the median arcuate ligament. Postoperatively, the patient's postprandial abdominal pain subsided. On 16 month follow-up, the patient was doing well, tolerated an unrestricted diet without symptoms, and exhibited weight gain. This case is the second reported in the literature and demonstrates that the robotic approach to division of the MAL is feasible, safe, and efficacious.

Síndrome del ligamento arcuato medio: a propósito de tres casos y revisión de la literatura

Median arcuate ligament syndrome (MALS) or celiac artery compression syndrome is caused by extrinsic compression of the median arcuate ligament, prominent fibrous bands and ganglionic periaortic tissue. It is asymptomatic on many occasions, but can present with symptoms such as, abdominal pain after eating or during exercise, nausea, vomiting, and loss of weight. We present three patients, one of whom was asymptomatic. The other two required surgical treatment, using laparoscopic release in one, and open surgery on the other. A clinical improvement was achieved in both cases and the follow-up by colour Doppler ultrasound was satisfactory. MALS is a rare abdominal pain condition. The less invasive diagnostic techniques, such as colour Doppler ultrasound and pre-operative angioCT, obtain good results compared to angioplasty. Surgical treatment using a laparoscopic approach, whether or not it is associated with endovascular revascularisation treatment, is a safe and effective therapeutic technique.

Hybrid Treatment of Celiac Artery Compression (Median Arcuate Ligament) Syndrome

Hybrid Treatment of Celiac Artery Compression (Median Arcuate Ligament) Syndrome

Celiac Artery Compression Syndrome: An Experience in a Single Institution in Taiwan

Celiac artery compression syndrome (CACS) or median arcuate ligament (MAL) syndrome is a rare vascular disease. The clinical manifestations of CACS include the triad of postprandial pain, vomiting, and weight loss. The pathogenesis of CACS is the external compression of celiac artery by the MAL or celiac ganglion. Moreover, some authors also reported the compression with different etiologies, such as neoplasms of pancreatic head, adjacent duodenal carcinoma, vascular aneurysms, aortic dissection, or sarcoidosis. In the literature, most cases of CACS were reported from Western countries. In contrast, this disease was seldom reported in Oriental countries or regions, including Taiwan. Superior mesenteric artery syndrome (SMAS) is also a rare disease characterized by compression of the third portion of the duodenum by the SMA. The clinical features of SMAS are postprandial pain, vomiting, and weight loss. To date, there are no guidelines to ensure the proper treatment of patients with CACS because of its low incidence. Thus, tailored therapy for patients with CACS remains a challenge as well as the prediction of clinical response and prognosis. The aim of our present study was to investigate the clinical features, the association with SMAS, treatments, and outcomes of patients with CACS in a single institution in Taiwan.

Laparoscopic Surgery for Coeliac Artery Compression Syndrome: Current Management and Technical Aspects

Determine if arm veins are good conduits for infrainguinal revascularisation and should be used when good quality saphenous vein is not available. Retrospective study. We evaluated a consecutive series of infrainguinal bypass (IB) using arm vein conduits from March 2001 to December 2006.We selected arm vein by preoperative ultrasound mapping to identify suitable veins. We measured vein diameter and assessed vein wall quality. We followed patients with systematic duplex imaging at 1 week, 1, 3, 6 and 12 months, and annually thereafter. We treated significative stenoses found during the follow-up. We performed 56 infrainguinal revascularisation using arm vein conduits in 56 patients. Primary patency rates at 1, 2 and 3 years were 65%, 51% and 47%. Primary assisted patencies at 1, 2 and 3 years were 96%, 96% and 82%. Secondary patency rates at 1, 2 and 3 years were 92%, 88% and 88%. The three-year limb salvage rate was 88%. We conclude that infrainguinal bypass using arm vein for conduits gives good patency rates, if selected by a preoperative US mapping to use the best autogenous conduit available.

Laparoscopic Surgery for Coeliac Artery Compression Syndrome: Current Management and Technical Aspects

Objectives The study aims to assess the feasibility and midterm outcome of trans-peritoneal laparoscopy for coeliac artery compression syndrome (CACS). Design Retrospective chart review involving four European vascular surgery departments and two surgical teams. Materials and methods charts for patients who underwent laparoscopy for symptomatic CACS between December 2003 and November 2009 were reviewed. Preoperative computed tomography (CT) angiography and postoperative duplex scan and/or CT angiography were performed. Results Eleven consecutive patients (nine women) with a median age of 52 years (interquartile range: 42.5–59 years) underwent trans-peritoneal laparoscopy for CACS. All patients had a history of postprandial abdominal pain; weight loss exceeded 10% of the body mass in eight cases. Preoperative CT angiography revealed coeliac trunk stenosis >70% in all cases. One patient had additional aortitis and inferior mesenteric artery occlusion, while another patient presented with an occluded superior mesenteric artery. Two conversions occurred (one difficult dissection and one aorto-hepatic bypass needed for incomplete release of CACS). The median blood loss was 195 ml (range: 50–900 ml) and median operative time was 80 min (interquartile range: 65–162.5 years). Symptoms improved immediately in 10/11 patients (no residual stenosis) while one remained unchanged despite a residual stenosis treated by a percutaneous angioplasty. Symptoms reappeared in one patient due to coeliac axis occlusion. The mean follow-up period was 35 ± 23 months (range: 12–78 months). Conclusion Our study demonstrates that trans-peritoneal laparoscopy for treating median arcuate ligament syndrome is safe and feasible. Additional patients and a longer follow-up are needed for long-term assessment of this laparoscopic technique.

Recurrent Celiac Artery Compression Syndrome.

The celiac artery compression syndrome (CACS) is an infrequently described clinical condition with poorly defined diagnostic criteria and an obscure pathophysiology. It is usually associated with an extrinsic compression upon the celiac axis near its takeoff from the aorta by fibrous diaphragmatic bands or sympathetic neural fibers. We present a patient with CACS who suffered a recurrence of her original abdominal complaints.http://link.springer-ny.com/link/service/journals/00547/bibs/8n3p150.html

Is celiac artery compression syndrome genetically inherited?: A case series from a family and review of the literature

The median arcuate ligament is a tendinous arch joining the two medial borders of the diaphragm crura together. In 13-50% of asymptomatic subjects it is responsible for significant angiographic celiac trunk compression. The significance of median arcuate ligament-associated celiac artery compression has been a source of some controversy in the past literature, and the etiology remains unclear. We report here a case series from a family that was diagnosed by the use of multidetector computed tomography. The observation of this syndrome in a family suggests that the responsible anatomic relationships are congenital and may be genetically inherited.

Treatment Options and Outcomes for Celiac Artery Compression Syndrome

Abdominal pain attributed to compression of the celiac artery at the level of the median arcuate ligament (MAL) of the diaphragm is an uncommon disorder. Although ultrasound investigation and arteriography can be suggestive of the diagnosis, no definitive criteria exist with only cases reports in the literature. This study presents the only known reported case series in which a combination of open and laparoscopic access techniques of MAL decompression are reported. A retrospective review of prospectively collected electronic databases of the University of North Carolina at Chapel Hill was performed for the period February 1999 until February 2009. Patients having undergone operation for celiac artery compression syndrome were identified and participated in a telephone interview. Questions were asked about the success of the operation, the recovery period, and patient satisfaction. Six patients were identified, 3 were male; mean age was 37.7 years. Four underwent open MAL division and celiac ganglion neurolysis, and 2 underwent a laparoscopic approach. Mean follow-up was 48.6 months. All patients experienced symptomatic improvement and were satisfied with their outcome. No patient had symptoms recurrence. In this limited experience, MAL division with celiac ganglion neurolysis appears to be an effective treatment for celiac artery compression syndrome in appropriately selected patients. Both the open and laparoscopic approaches are safe with durable midterm follow-up results.

Laparoscopic Release of the Median Arcuate Ligament for Celiac Artery Compression Syndrome in the Community Hospital Setting: A Case Report

Introduction: Celiac artery compression syndrome (CACS) is a rare disorder causing postprandial abdominal pain and weight loss secondary to mechanical compression of the celiac axis by an abnormally low insertion of the diaphragm at the median arcuate ligament (MAL). Historically, correction was performed through an upper midline laparotomy and release of the muscular fibers of the MAL causing celiac axis compression. Advanced laparoscopic techniques have been recently employed by some authors to confer the benefits of minimally invasive surgery to this patient population1–4 in the academic setting. We present a case of successful laparoscopic release of the MAL for CACS in the community hospital setting. Case: A 66-year-old man with longstanding history of postprandial abdominal pain and weight loss was referred for possible CACS. A mesenteric arteriogram was performed, which demonstrated a high-grade stenosis in the proximal celiac axis. The patient was prepared for a laparoscopic release of the MAL. A fellowship-trained minimally invasive/bariatric surgeon (T.S.D.) and a fellowship-trained vascular surgeon (W.K.) performed the operation. The patient was placed in the supine position with arms extended. A footboard was utilized to allow full reverse Trendelenburg position to be employed. Abdominal access was achieved using an Optiview approach through a left subcostal anterior axillary 12-mm incision. A 12-mm trocar was placed midway between the umbilicus and xyphoid process, two additional right upper quadrant ports were placed (5 mm, 12 mm), and a Nathanson liver retractor was placed through a 5-mm subxyphoid incision. The lesser sac was accessed by opening gastrocolic and gastrospenic attachments using an ultrasonic dissector. Both the left lobe of the liver and stomach were retracted anteriorly using the Nathanson retractor, allowing full view of the lesser sac and retroperitoneum. The left gastric, common hepatic, and splenic arteries were identified and traced back to the celiac trifurcation. The celiac axis was then circumferentially dissected and a vessel loop was applied. The area of compression was readily apparent upon gentle caudal retraction of the celiac artery. Monopolar hook electocautery was employed to carefully release the muscular attachments of the MAL that were causing arterial compression. The MAL was completely released when the supraceliac aorta was fully exposed from muscular diaphragmatic fibers. The patient did well postoperatively and was discharged home with an indwelling Foley catheter secondary to urinary retention and benign prostatic hypertrophy. Upon 2-week follow-up, the patient described full resolution of postprandial symptoms. Before surgery, the patient describes only tolerating full liquids, but at follow-up, is able to tolerate a regular solid diet for the first time in years. Conclusion: Laparoscopic release of the MAL for CACS is a technically demanding procedure with a high risk of open conversion and complications, even in the academic setting. However, with appropriately trained surgeons, this rare disorder can be treated in community hospital setting. No competing financial interests exist. Runtime of video: 5 mins 03 secs

Two Cases of Hepatocellular Carcinoma Complicated with Celiac Artery Compression Syndrome Treated Successfully by Trans-arterial Embolization after Dissection of the Median Arcuate Ligament under Laparotomy

腹腔動脈起始部圧迫症候群を合併した肝細胞癌（hepatocellular carcinoma；以下，HCCと略記）に対し，経肝動脈的治療導入を目的に行った正中弓状靭帯切離が有効であった2例を経験したので報告する．症例1は56歳の男性で，血管造影で腹腔動脈根部は狭窄し，肝血流は上腸間膜動脈から供給されていた．HCCに対し肝動脈塞栓療法を試みるも治療に難渋した．開腹下に正中弓状靭帯を切離行い，腹腔動脈根部の圧迫を解除し，経肝動脈的治療を継続中である．症例2は66歳の女性で，血管造影で腹腔動脈根部の狭窄と上腸間膜動脈から供給される肝血流を認めた．HCCに対し肝外側区域切除と，将来の経肝動脈的治療導入に備え正中弓状靭帯切離を行った．現在術後再発病変に対して肝動脈塞栓療法を行っている．腹腔動脈起始部圧迫症候群に対する正中弓状靭帯切離は，経肝動脈的治療を要する症例には，積極的に試みてよい手技と考えられた．

A rare case of a complete left inferior vena cava associated with the symptoms of Dunbar syndrome

We report a case of an 82-year-old female with an anomalous left inferior vena cava. The left inferior vena cava ascends parallel and to the left of the descending abdominal aorta. At the level of the celiac trunk, the inferior vena cava courses anteriorly and to the right to reach the posterior surface of the liver. The patient also suffers from chronic mild postprandial abdominal pain. It is possible that position of inferior vena cava anterior to the aorta, at the level of the celiac trunk, may lead to intermittent celiac artery compression syndrome (Dunbar syndrome).

Chronic atherosclerotic mesenteric ischemia (CMI)

Chronic mesenteric ischemia (CMI) is most likely caused by atherosclerosis and less frequently by external compression and vasculitis. Symptomatic CMI is an uncommon, potentially under-diagnosed condition caused by fixed stenoses or occlusion of, in most conditions, at least two visceral arteries. If only one of the three major bowel-providing arteries - the celiac trunk, and the superior and inferior mesenteric arteries - is affected, the patient is usually asymptomatic due to a tight collateral network. The only exception is the celiac artery compression syndrome which represents primarily a compression syndrome of celiac plexus nerves by the arcuate ligament in conjunction with a compression of the celiac trunk. CMI of atherosclerotic origin is associated with a high morbidity and mortality. During the last decade, endovascular revascularization has replaced surgical revascularization as the therapy of choice in most centers. This article reviews the most relevant clinical aspects of the disease and the current practice of diagnosis and treatment of CMI.

Median Arcuate Ligament Syndrome: Vascular Surgical Therapy and Follow-up of 18 Patients

Introduction The median arcuate ligament syndrome (MALS) or celiac artery compression syndrome is a rare vascular disorder caused by an extrinsic compression of the celiac artery from the median arcuate ligament, prominent fibrous bands, and ganglionic periaortic tissue. Clinical symptoms are postprandial abdominal pain, nausea, vomiting, unintentional weight loss, and sometimes, abdominal pain during body exercise caused by an intermittent visceral ischemia. The aim of this study was to evaluate the operative management of patients with MALS in our institution, especially in consideration of various vascular reconstructive techniques.

Endovascular Treatment of Chronic Arterial Mesenteric Ischemia: A changing perspective?

Endovascular treatment for chronic mesenteric ischemia is growing in popularity because of its lower periprocedural morbidity and mortality than open surgery. It is especially suitable for the high-risk surgical candidate and for those who have a poor nutritional state, although endovascular surgery may not be possible in patients with ostial occlusions or heavily calcified vessels. A positive response to angioplasty is helpful to secure a diagnosis in patients with slightly atypical symptoms. There are little data at present to suggest that primary stenting is better than angioplasty alone, but insertion of a stent may be valuable as a rescue procedure following dissection, vascular recoil, or thrombosis during angioplasty. The superior mesenteric artery is probably the most important vessel to treat but, where this is impossible, celiac or inferior mesenteric artery dilatation may have therapeutic benefit. However, there is some evidence at present favoring multiple, as opposed to single-vessel, angioplasty or stenting. Long-term patency is better after mesenteric bypass, which may be preferred in the younger and fitter patient. Treatment of the celiac artery compression syndrome is primarily surgical, but stent insertion may have a role as a secondary procedure where there is a residual stenosis after median arcuate ligament division.

Celiac artery compression syndrome

The purpose of the Journal of the Belgian Society of Radiology is the publication of articles dealing with diagnostic and interventional radiology, related imaging techniques, allied sciences, and continuing education