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The celiac axis compression syndrome (CACS): critical review in the laparoscopic era
Javier A Cienfuegos1, F Rotellar, V Valentí
1Department of General and Digestive Surgery, Clínica Universidad de Navarra, Pamplona, Spain. fjacien@unav.es
Insights
Celiac axis compression syndrome (CACS) involves median arcuate ligament (MAL) issues causing pain and weight loss. Advanced imaging and new treatments offer improved understanding and management of this complex condition.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Celiac axis compression syndrome (CACS) is linked to median arcuate ligament (MAL) entrapment, first described in 1963.
- Key symptoms include postprandial abdominal pain, weight loss, epigastric bruit, and significant celiac artery stenosis (>75%).
- The syndrome's pathogenesis, diagnosis, and long-term outcomes have been subjects of ongoing debate.
Purpose of the Study:
- To critically review the current understanding and management of celiac axis compression syndrome.
- To highlight advancements in diagnostic imaging and therapeutic approaches for MAL-associated CACS.
- To present insights based on the authors' clinical experience.
Main Methods:
- Review of diagnostic imaging modalities including 64 multidetector-row CT (MDCT), 3-D reconstruction, MRI, and color duplex ultrasonography.
- Consideration of minimally invasive treatment options: laparoscopic surgery and endovascular procedures introduced around 2000.
- Critical analysis of the syndrome's clinical presentation, diagnostic criteria, and treatment efficacy.
Main Results:
- Advanced imaging techniques improve the understanding of CACS and aid in identifying suitable candidates for MAL surgical division.
- The introduction of laparoscopic and endovascular procedures has provided new therapeutic perspectives for this challenging syndrome.
- The authors' experience contributes to a more informed critical review of CACS management.
Conclusions:
- Modern diagnostic tools enhance the evaluation of celiac axis compression syndrome.
- Minimally invasive surgical and endovascular interventions represent significant advancements in treating MAL-induced CACS.
- A comprehensive review, informed by clinical experience, is crucial for optimizing patient care in CACS.
Abstract:
The celiac axis compression syndrome (CACS) due to median arcuate ligament (MAL) was first described by Harjola in 1963; originating postpandrial abdominal pain, weight loss, epigastric bruit and celiac axis stenosis > 75% in angiographic studies. This clinical condition has been the origin of controversies about its pathogenesis, diagnosis and its long term clinical results. Advances in diagnostic imaging as 64 multidetector-row CT (MDCT), 3-D reconstruction, magnetic resonance (MR) and color duplex ultrasonography, provide better understanding of the syndrome and allow to identify the best candidates for surgical division of MAL fibers. Since the introduction of laparoscopic approach, and also endovascular procedures, in 2000, a new perspective has established in this challenging syndrome. With the occasion of our own experience, a critical review of the syndrome is presented.