TY - JOUR
T1 - Median arcuate ligament syndrome
T2 - Open celiac artery reconstruction and ligament division after endovascular failure
AU - Delis, Konstantinos T.
AU - Gloviczki, Peter
AU - Altuwaijri, Maraya
AU - McKusick, Michael A.
PY - 2007/10
Y1 - 2007/10
N2 - Median arcuate ligament syndrome (MALS) is a rare disorder resulting from extrinsic compression and narrowing of the celiac artery, and-less often-the superior mesenteric artery, by the relatively low insertion of the ligament and/or prominent fibrous bands or ganglionic periaortic tissue of the celiac nervous plexus. We report on a young woman who after three consecutive attempts of endovascular therapy with balloon angioplasty and stenting for MALS, each followed by gross symptom recurrence and a cumulative weight loss of 10 kg, underwent open surgical division of the ligament and reconstruction of the celiac artery. Despite the initial response of MALS to endovascular therapy, the extrinsic pressure exerted on the celiac artery by the surrounding dense fibrous/ganglionic tissue resulted in slippage of the stents and/or failure of their material. These findings militate against the use of balloon angioplasty and stenting primarily in patients with MALS without prior release of the extrinsic compression on the celiac (and/or superior mesenteric) artery by dividing the surrounding median arcuate ligament and/or ganglionic tissue with open or laparoscopic surgery.
AB - Median arcuate ligament syndrome (MALS) is a rare disorder resulting from extrinsic compression and narrowing of the celiac artery, and-less often-the superior mesenteric artery, by the relatively low insertion of the ligament and/or prominent fibrous bands or ganglionic periaortic tissue of the celiac nervous plexus. We report on a young woman who after three consecutive attempts of endovascular therapy with balloon angioplasty and stenting for MALS, each followed by gross symptom recurrence and a cumulative weight loss of 10 kg, underwent open surgical division of the ligament and reconstruction of the celiac artery. Despite the initial response of MALS to endovascular therapy, the extrinsic pressure exerted on the celiac artery by the surrounding dense fibrous/ganglionic tissue resulted in slippage of the stents and/or failure of their material. These findings militate against the use of balloon angioplasty and stenting primarily in patients with MALS without prior release of the extrinsic compression on the celiac (and/or superior mesenteric) artery by dividing the surrounding median arcuate ligament and/or ganglionic tissue with open or laparoscopic surgery.
UR - http://www.scopus.com/inward/record.url?scp=34548832727&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34548832727&partnerID=8YFLogxK
U2 - 10.1016/j.jvs.2007.05.049
DO - 10.1016/j.jvs.2007.05.049
M3 - Article
C2 - 17903658
AN - SCOPUS:34548832727
SN - 0741-5214
VL - 46
SP - 799
EP - 802
JO - Journal of vascular surgery
JF - Journal of vascular surgery
IS - 4
ER -