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Median Arcuate Ligament Syndrome: Where Are We Today?

Kayden Maddox1, Timothy M Farrell2, Luigi Pascarella3

  • 1University of North Carolina School of Medicine, Chapel Hill, NC, USA.

The American Surgeon
|October 17, 2024
PubMed

Insights

Median arcuate ligament syndrome (MALS) symptoms may stem from celiac ganglion compression, not just the celiac artery. This review highlights the need for better diagnostics and a multidisciplinary approach for faster patient relief.

Area of Science:

  • Gastroenterology
  • Vascular Surgery
  • Pain Management

Background:

  • Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, has traditionally been linked to celiac trunk compression.
  • Emerging evidence suggests MALS symptoms may be more closely related to chronic compression of the celiac ganglion.

Purpose of the Study:

  • To provide a comprehensive review of current Median arcuate ligament syndrome literature.
  • To emphasize the necessity of a multidisciplinary approach for MALS patient care.
  • To highlight the need for improved diagnostic protocols and understanding of MALS pathophysiology.

Main Methods:

  • Literature review of current MALS research.
  • Analysis of clinical presentation, histology, and treatment outcomes.
  • Discussion of diagnostic challenges and patient management strategies.

Main Results:

  • Patients with MALS often experience diagnostic delays, averaging 10.5 months to 2.6 years.
  • A shift in understanding MALS pathophysiology from celiac trunk compression to celiac ganglion compression is occurring.
  • Multidisciplinary care is crucial for managing MALS patients effectively.

Conclusions:

  • Further research is needed to clarify MALS pathophysiology and improve diagnostic accuracy.
  • A better understanding of MALS will facilitate earlier diagnosis and treatment, reducing patient suffering.
  • Moving MALS from a diagnosis of exclusion to a standard work-up is essential for timely symptom relief.

Keywords:
esophagus/foreguthistoryminimally invasive surgerysurgical qualityvascular surgery

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