Mustafa KOÇ, Hakan ARTAŞ, Selami SERHATLIOĞLU

The investigation of incidence and multidetector computed tomography findings of median arcuate ligament syndrome

Background/aim: This study aims to evaluate the incidence and multidetector computed tomography (MDCT) findings of medianarcuate ligament syndrome (MALS).Materials and methods: Between January 2010 and September 2016 a total of 4028 patients who underwent angiography for MDCTbased on the clinical indications for abdominal pain were retrospectively analyzed.Results: The typical signs of MALS were identified in a total of 141 (3.5%) patients. Among all patients, 84 (59%) were male and 57(41%) were female. The mean age was 42 years (range: 24 to 71 years). The incidence of celiac artery stenosis was 30% to 50% in 45patients (32%) and 51% to 90% in 96 patients (68%). Poststenotic dilatation was reported in 74 patients (52%). Collateral vascularstructures from the superior mesenteric artery were observed in 5 patients (3.5%). Twenty-one patients (14.9%) underwent laparoscopicsurgery with significant stenosis.Conclusion: MALS is a rare vascular pathology. It is especially important to recognize the presence of MALS with an epigastric painthat increases with expiration in adults and also its etiology before interventional procedures. MDCT visualization made the diagnosisof MALS easy.

PDF

___

Harjola PT. A rare obstruction of the coeliac artery. Report of a case. Ann Chir Gynaecol Fenn 1963; 52: 547-550.
Dunbar JD, Molnar W, Beman FF, Marable SA. Compression of the celiac trunk and abdominal angina. Am J Roentgenol Radium Ther Nucl Med 1965; 95: 731-744.
Fong JK, Poh AC, Tan AG, Taneja R. Imaging findings and clinical features of abdominal vascular compression syndromes. AJR Am J Roentgenol 2014; 203: 29-36.
Aswani Y, Thakkar H, Anandpara KM. Imaging in median arcuate ligament syndrome. BMJ Case Rep 2015; 2015: bcr2014207856.
Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics 2005; 25: 1177-1182.
Lee VS, Morgan JN, Tan AG, Pandharipande PV, Krinsky GA, Barker JA, Lo C, Weinreb JC. Celiac artery compression by the median arcuate ligament: a pitfall of end-expiratory MR imaging. Radiology 2003; 228: 437-442.
Jaik NP, Stawicki SP, Weger NS, Lukaszczyk JJ. Celiac artery compression syndrome: successful utilization of roboticassisted laparoscopic approach. J Gastrointestin Liver Dis 2007; 16: 93-96.
Desmond CP, Roberts SK. Exercise-related abdominal pain as a manifestation of the median arcuate ligament syndrome. Scand J Gastroenterol 2004; 39: 1310-1313.
Ikeda O, Tamura Y, Nakasone Y, Yamashita Y. Celiac artery stenosis/occlusion treated by interventional radiology. Eur J Radiol 2009; 71: 369-377.
Marcoccia A, Zippi M, Bruni A, Salvatori FM, Badiali D, Donato G, Picarelli A. Chronic abdominal pain associated with intermittent compression of the celiac artery. Minerva Gastroenterol Dietol 2007; 53: 209-213.
Sianesi M, Soliani P, Arcuri MF, Bezer L, Iapichino G, Del Rio P. Dunbar’s syndrome and superior mesenteric artery’s syndrome: a rare association. Dig Dis Sci 2007; 52: 302-305.
Başkan Ö, Özdenkaya Y, Erol C, Dolay K. Problems with the median arcuate ligament should be recognized before surgery; its importance in pancreaticoduodenectomy. Balkan Med J 2015; 32: 312-315.
Scholbach T. Celiac artery compression syndrome in children, adolescents, and young adults: clinical and color duplex sonographic features in a series of 59 cases. J Ultrasound Med 2006; 25: 299-305.
Grotemeyer D, Duran M, Iskandar F, Blondin D, Nguyen K, Sandmann W. Median arcuate ligament syndrome: vascular surgical therapy and follow-up of 18 patients. Langenbecks Arch Surg 2009; 394: 1085-1092.
Patten RM, Coldwell DM, Ben-Menachem Y. Ligamentous compression of the celiac axis: CT findings in five patients. AJR Am J Roentgenol 1991; 156: 1101-1103.
Karahan OI, Kahriman G, Yikilmaz A, Ok E. Celiac artery compression syndrome: diagnosis with multislice CT. Diagn Interv Radiol 2007; 13: 90-93.
Kazan V, Qu W, Al-Natour M, Abbas J, Nazzal M. Celiac artery compression syndrome: a radiological finding without clinical symptoms? Vascular 2013; 21: 293-299.
Roayaie S, Jossart G, Gitlitz D, Lamparello P, Hollier L, Gagner M. Laparoscopic release of celiac artery compression syndrome facilitated by laparoscopic ultrasound scanning to confirm restoration of flow. J Vasc Surg 2000; 32: 814-817.
Hongsakul K, Rookkapan S. Sungsiri J, Tubtawee T. A severe case of median arcuate ligament syndrome with successful angioplasty and stenting. Case Rep Vasc Med 2012; 2012: 129870.
Van Petersen AS, Vriens BH, Huisman AB, Kolkman JJ, Geelkerken RH. Retroperitoneal endoscopic release in the management of celiac artery compression syndrome. J Vasc Surg 2009; 50: 140-147.
Nyman U, Ivancev K, Lindh M, Uher P. Endovascular treatment of chronic mesenteric ischemia: report of five cases. Cardiovasc Intervent Radiol 1998; 21: 305-313.
Delis KT, Gloviczki P, Altuwaijri M, McKusick MA. Median arcuate ligament syndrome: open celiac artery reconstruction and ligament division after endovascular failure. J Vasc Surg 2007; 46: 799-802.