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Median arcuate ligament syndrome
Richard Goodall1, Benjamin Langridge1, Sarah Onida1
1Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom.
Journal of Vascular Surgery
|December 29, 2019
Summary
Median arcuate ligament syndrome (MALS) causes celiac artery compression, leading to foregut ischemia symptoms. Surgical decompression offers short-to-medium term relief, but long-term data and evidence-based guidelines are needed.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Median arcuate ligament syndrome (MALS) is characterized by celiac artery compression by the median arcuate ligament.
- The pathophysiology, variable symptoms, and unpredictable treatment responses contribute to MALS being a controversial diagnosis.
Purpose of the Study:
- To review the literature on MALS, covering its pathophysiology, presentation, diagnosis, and management.
- To propose a diagnostic workup and treatment algorithm for MALS.
Main Methods:
- Literature review summarizing existing research on MALS.
- Presentation of a diagnostic and treatment algorithm.
Main Results:
- MALS patients exhibit foregut ischemia symptoms like epigastric pain, nausea, vomiting, and weight loss, often with delayed diagnosis.
- Diagnostic criteria lack consensus, with varied use of ultrasound, angiography, and tonometry.
- Surgical decompression provides short-to-medium term relief, but long-term outcomes and comparative data are lacking; nonoperative management appears less effective.
Conclusions:
- MALS is a significant clinical condition with consistent symptoms and short-to-medium term surgical response.
- Further prospective studies are required to compare long-term outcomes of operative versus nonoperative management and to develop evidence-based guidelines.
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