Article

Hybrid Treatment of Celiac Artery Compression (Median Arcuate Ligament) Syndrome

Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Digestive Diseases and Sciences (Impact Factor: 2.55). 01/2012; 57(7):1782-5. DOI: 10.1007/s10620-011-2019-x
Source: PubMed
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    ABSTRACT: Median arcuate ligament syndrome (MALS) is a rare disorder defined by compression and narrowing of the celiac artery by the median arcuate ligament. The increased blood flow through the pancreaticoduodenal arcade can lead to the aneurysmal formation withing the vessel. We report three cases of pancreaticoduodenal aneurysms (PDAA) in patients with MALS whose aneurysms were occluded, but celiac artery revascularization was not performed. CASE 1: Asymptomatic 61 year-old female with no past medical history was referred to vascular surgery for evaluation of a PDAA incidentally found on CT scan. The patient was taken for laparoscopic division of the median arcuate ligament, however, the release was incomplete. This was followed by endovascular coil embolization of the PDAA without celiac revascularization. The patient tolerated the procedure well with no complications and the one year follow-up shows no signs of aneurysm recurrence. CASE 2: 61 year-old male found to have an incidental PDAA on CT scan. The patient was taken for coil embolization without median arcuate ligament release. At the one year follow-up the patient continues to be asymptomatic with no recurrence. CASE 3: 56 year-old male who presented with a ruptured PDAA. He was taken immediately for coil embolization of the ruptured aneurysm. Post-operatively, the patient was identified to have MALS on CT scan. Due to his asymptomatic history and benign physical examination before the rupture, he was not taken for a ligament release or celiac revascularization. He continues to be asymptomatic at his follow-up.
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