Median arcuate ligament syndrome: A nonvascular, vascular diagnosis

Nedaa Skeik, Leslie T Jr. Cooper, Audra A. Duncan, Fadi I. Jabr

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Median arcuate ligament syndrome (MALS) is often diagnosed when idiopathic, episodic abdominal pain is associated with dynamic compression of the proximal celiac artery by fibers of the median arcuate ligament. The character of the abdominal pain is often postprandial and associated with gradual weight loss from poor food intake, suggestive of chronic mesenteric ischemia. However, the pathognomonic imaging feature of dynamic, ostial celiac artery compression with expiration does not consistently predict clinical improvement from revascularization. Proposed but unproven pathophysiological mechanisms include neurogenic pain from compression of the splanchnic nerve plexus and intermittent ischemia from compression of the celiac artery. Alterations in blood flow and ganglion compression are both associated with delayed gastric emptying, another physiological correlate of the clinical syndrome. Published reports describe a variable response to revascularization and nerve plexus resection suggest a need for translational research to better characterize this poorly understood clinical entity. We illustrate the current gaps in our knowledge of MALS with the case of a 51-year-old woman with a 4-year history of chronic abdominal pain who responded to a combination of ganglion resection and celiac artery reconstruction.

Original languageEnglish (US)
Pages (from-to)433-437
Number of pages5
JournalVascular and Endovascular Surgery
Volume45
Issue number5
DOIs
StatePublished - Jul 2011

Fingerprint

Celiac Artery
Blood Vessels
Abdominal Pain
Ganglia
Splanchnic Nerves
Translational Medical Research
Gastric Emptying
Ligaments
Chronic Pain
Weight Loss
Ischemia
Eating
Pain
Celiac Artery Stenosis from Compression by Median Arcuate Ligament of Diaphragm

Keywords

  • chronic mesenteric ischemia
  • median arcuate ligament syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Median arcuate ligament syndrome : A nonvascular, vascular diagnosis. / Skeik, Nedaa; Cooper, Leslie T Jr.; Duncan, Audra A.; Jabr, Fadi I.

In: Vascular and Endovascular Surgery, Vol. 45, No. 5, 07.2011, p. 433-437.

Research output: Contribution to journalArticle

Skeik, Nedaa ; Cooper, Leslie T Jr. ; Duncan, Audra A. ; Jabr, Fadi I. / Median arcuate ligament syndrome : A nonvascular, vascular diagnosis. In: Vascular and Endovascular Surgery. 2011 ; Vol. 45, No. 5. pp. 433-437.
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