Median arcuate ligament syndrome: vascular surgical therapy and follow-up of 18 patients.
ABSTRACT The median arcuate ligament syndrome (MALS) or celiac artery compression syndrome is a rare vascular disorder caused by an extrinsic compression of the celiac artery from the median arcuate ligament, prominent fibrous bands, and ganglionic periaortic tissue. Clinical symptoms are postprandial abdominal pain, nausea, vomiting, unintentional weight loss, and sometimes, abdominal pain during body exercise caused by an intermittent visceral ischemia. The aim of this study was to evaluate the operative management of patients with MALS in our institution, especially in consideration of various vascular reconstructive techniques.
Between June 2000 and January 2009, a total of 341 patients were treated in our department for vascular pathologies of the visceral arteries (225 chronic visceral ischaemia, 84 acute visceral ischaemia, and 14 visceral artery aneurysms). In a retrospective study of 18 patients with MALS, the records, clinical symptoms, diagnostic evaluation, and surgical procedures were compiled. This was completed by a reassessment for a follow-up.
A MALS was diagnosed in 15 female (83.3%) and three male (16.7%) patients. The mean patient age was 46.2 years (range 20-68 years). The diagnosis of MALS was based on a radiological analysis in all patients by a digitally subtracted angiogram, but duplex ultrasound was used lately more frequently to study the influence of respiration on the stenotic degree of the celiac trunk. All 18 patients were treated with open surgery in an elective situation. Due to the local and specific pathology of the celiac trunk with a fixed stricture or stenosis, out of 18 cases beside decompression, 11 (primary, seven; secondary, four patients) further procedures were performed on the celiac artery (aorto-celiac vein interposition n = 6, aorto-hepatic vein interposition n = 1, resection of the celiac artery and end-to-end anastomosis n = 2, patchplasty of the celiac artery with vein n = 1, and transaortic removal of a stent of the celiac artery n = 1) Follow-up was obtained in 15 patients (83.33%) with a mean duration after surgery of about three and a half years (40.68 months, range from 2 to 102 months). Eleven of the 15 patients (73.33%) were completely free of abdominal symptoms, and nine of them had gained between 3 and 10 kg in weight after surgery. The weight of two patients remained stable. Of the 11 patients with a successful outcome in the follow-up, six of them had undergone decompression solely. In the other five patients, vascular co-procedures on the celiac trunk had been performed.
The MALS is a rare vascular disorder caused by an extrinsic compression of the celiac artery and induces upper abdominal, mostly, postprandial pain. A definite diagnosis of MALS can be achieved by lateral aortography of the visceral aorta and its branches during inspiration and expiration. Open surgical therapy is a safe and reliable procedure with no mortality and low morbidity. As to the local and specific pathology of the celiac trunk after decompression with fixed stricture or stenosis, further vascular procedures are necessary. The long-time follow-up seemed adequate. The laparoscopic approach reduces the procedure of decompression only, something which seemed inadequate for most cases. Endovascular treatment with percutaneous transluminal angioplasty and insertion of a stent does not solve the underlying problem of extrinsic compression of the celiac trunk and often requires open procedures during the long-term course. Due to the low incidence of MALS, no guidelines will do justice to all the patients sufficiently, and the choice of treatment must depend on the specific clinical situation for each patient.
- SourceAvailable from: ncbi.nlm.nih.gov
[Show abstract] [Hide abstract]
- "Moreover, some authors suggested additional arterial reconstruction of the entrapped celiac artery by primary reanastomosis, interposition grafting, or bypass to offer better outcome  . The average rate of being symptom-free is around 70–80% after successful surgery based on long-term followup . Although the success rates of open surgery on vascular patency are excellent, "
ABSTRACT: Celiac artery compression syndrome (CACS) or median arcuate ligament (MAL) syndrome is a rare vascular disease. The clinical manifestations of CACS include the triad of postprandial pain, vomiting, and weight loss. The pathogenesis of CACS is the external compression of celiac artery by the MAL or celiac ganglion. Moreover, some authors also reported the compression with different etiologies, such as neoplasms of pancreatic head, adjacent duodenal carcinoma, vascular aneurysms, aortic dissection, or sarcoidosis. In the literature, most cases of CACS were reported from Western countries. In contrast, this disease was seldom reported in Oriental countries or regions, including Taiwan. Superior mesenteric artery syndrome (SMAS) is also a rare disease characterized by compression of the third portion of the duodenum by the SMA. The clinical features of SMAS are postprandial pain, vomiting, and weight loss. To date, there are no guidelines to ensure the proper treatment of patients with CACS because of its low incidence. Thus, tailored therapy for patients with CACS remains a challenge as well as the prediction of clinical response and prognosis. The aim of our present study was to investigate the clinical features, the association with SMAS, treatments, and outcomes of patients with CACS in a single institution in Taiwan.Gastroenterology Research and Practice 09/2012; 2012:935721. DOI:10.1155/2012/935721 · 1.50 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Stenosen und Verschlüsse des aortoarteriellen Systems kommen grundsätzlich in jedem Lebensabschnitt, also auch im frühesten Kindesalter, vor. Unser jüngster Patient war zum Zeitpunkt der Operation gerade wenige Stunden alt. Das Kind hatte eine aortoarterielle Thrombose entwickelt und zeigte neben der Beinischämie bereits einen beginnenden ischämischen Hautschaden im Fußbereich. Es wurde mit dem von Thomas Fogarty 1963 entwickelten Ballonkatheter erfolgreich transinguinal thromboembolektomiert (Abb. 1 a, b). Dieser Katheter wird industriell in den kleinsten Durchmessern gefertigt und spielt im Konzept der operativen Behandlung akuter Verschlüsse gerade bei Kindern eine wichtige Rolle, weil sich dadurch Einund Rückstrom im eröffneten Gefäß „blockieren“ lassen und so den Verzicht auf die gelegentlich doch traumatisierenden Gefäßklemmen ermöglichen. Abb. 1 a, b. Wenige Stunden altes Neugeborenes mit akuter Ischämie des linken Beines aufgrund einer arteriellen Thrombose der Beckenstrombahn links. a Vor und b nach transfemoraler Thrombektomie mittels Fogarty-Katheter (Sättigungssonde am linken Großzeh)
Conference Paper: Adaptive filters based on the high order error statistics[Show abstract] [Hide abstract]
ABSTRACT: This paper presents convergence analyses of the stochastic gradient adaptive algorithms based on high order error power criteria. In particular, our attention has focused on investigating the statistical behaviour of the least mean absolute third (LMAT) and the least mean fourth (LMF) adaptive algorithms. For each algorithm, under a set of mild assumptions, we have derived nonlinear evolution equations that characterize the mean and mean-squared behaviour of the algorithm. Computer simulation examples show fairly good agreement between the theoretical and actual behaviour of the two algorithmsCircuits and Systems, 1996., IEEE Asia Pacific Conference on; 12/1996