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Median arcuate ligament syndrome
1Division of Vascular Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55902, USA. duncan.audra@mayo.edu
Current Treatment Options in Cardiovascular Medicine
|March 8, 2008
Summary
Median arcuate ligament syndrome (MALS) involves celiac artery compression. Diagnosis requires thorough evaluation, and open surgery is the most reliable treatment, though minimally invasive options exist for select patients.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Median arcuate ligament syndrome (MALS) presents with diverse gastrointestinal symptoms, including abdominal pain, nausea, vomiting, and weight loss.
- Distinguishing pathologic celiac artery compression by the median arcuate ligament (MAL) from incidental findings is challenging due to varying compression degrees.
- The etiology of MALS remains debated, with some physicians questioning the syndrome's validity.
Purpose of the Study:
- To outline diagnostic considerations and treatment strategies for patients with suspected median arcuate ligament syndrome.
- To emphasize the importance of a comprehensive gastrointestinal evaluation prior to intervention.
- To discuss the role of preoperative pain management assessment in optimizing surgical outcomes.
Main Methods:
- Review of diagnostic approaches, including temporary percutaneous celiac ganglion block.
- Assessment of preoperative pain management strategies and the impact of chronic narcotic use.
- Surgical intervention details, focusing on open division of the MAL, celiac ganglion management, and arterial assessment/reconstruction.
- Consideration of laparoscopic and endovascular techniques as alternative treatments.
Main Results:
- A thorough gastrointestinal evaluation is crucial before MALS intervention.
- Preoperative evaluation by a pain specialist is recommended for patients on chronic narcotics.
- Open surgical division of the MAL with potential celiac artery reconstruction is the most reliable treatment.
- Minimally invasive laparoscopic and endovascular options are available for select patients.
Conclusions:
- Accurate diagnosis of MALS requires excluding other gastrointestinal pathologies and careful assessment of celiac artery compression.
- Optimizing patient selection and preoperative management, including pain control, improves treatment success.
- Open surgery remains the gold standard, but alternative interventions offer options for specific patient groups.
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