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Median Arcuate Ligament Compression Associated with Flow-Related Visceral Aneurysms
Nicholas Xiao1, Arjun Ahuja1, Ricky Patel1
1Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois.
Journal of Vascular and Interventional Radiology : JVIR
|April 1, 2023
Summary
Median arcuate ligament (MAL) compression can cause visceral artery aneurysms (VAAs). Fusiform aneurysms are linked to rupture, and endovascular treatment offers a safe, effective solution for MAL-related VAAs.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Median arcuate ligament (MAL) compression is a rare condition affecting visceral arteries.
- Aneurysms associated with MAL compression (MALC-VAAs) can lead to significant complications, including rupture.
- Identifying risk factors and effective treatment strategies for MALC-VAAs is crucial.
Purpose of the Study:
- To identify risk factors for rupture in visceral artery aneurysms (VAAs) related to median arcuate ligament (MAL) compression.
- To determine the outcomes of endovascular treatment for MAL compression-associated VAAs.
Main Methods:
- A retrospective review of 21 patients with 39 MALC-related VAAs from 1999 to 2021.
- Analysis of imaging studies to assess aneurysm characteristics (number, morphology, size, recurrence).
- Statistical analysis to identify rupture risk factors.
Main Results:
- Ten patients presented with acute rupture; 12 were symptomatic.
- Fusiform morphology was significantly associated with acute hemorrhage (OR, 9.0; P < .01).
- Endovascular treatment of 31 aneurysms achieved 100% technical success with no recurrences during a mean 3.2-year follow-up.
Conclusions:
- MAL compression-associated VAAs require treatment, especially if fusiform, regardless of size.
- Endovascular therapy is a safe, feasible, and durable option for excluding these aneurysms.
- No surgical ligament release was necessary in this cohort.
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