Factors associated with successful median arcuate ligament release in an international, multi-institutional cohort.

Autor:	DeCarlo C; Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: csdecarlo@partners.org., Woo K; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA., van Petersen AS; Department of Vascular Surgery, Bernhoven Hospital, Uden, Netherlands., Geelkerken RH; Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, Netherlands., Chen AJ; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA., Yeh SL; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA., Kim GY; Division of Vascular Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI., Henke PK; Division of Vascular Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI., Tracci MC; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA., Schneck MB; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA., Grotemeyer D; Department of Vascular Surgery, Hôpitaux Robert Schuman - Hopital Kirchberg, Luxembourg, MN., Meyer B; Department of Vascular Surgery, Hôpitaux Robert Schuman - Hopital Kirchberg, Luxembourg, MN., DeMartino RR; Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN., Wilkins PB; Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN., Iranmanesh S; Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA., Rastogi V; Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA., Aulivola B; Division of Vascular and Endovascular Surgery, Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL., Korepta LM; Division of Vascular and Endovascular Surgery, Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL., Shutze WP; Division of Vascular Surgery, Department of Surgery, The Heart Hospital Plano, Plano, TX., Jett KG; Division of Vascular Surgery, Department of Surgery, The Heart Hospital Plano, Plano, TX., Sorber R; Division of Vascular and Endovascular Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD., Abularrage CJ; Division of Vascular and Endovascular Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD., Long GW; Division of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, MI., Bove PG; Division of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, MI., Davies MG; Division of Vascular and Endovascular Surgery, Long School of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, TX., Miserlis D; Division of Vascular and Endovascular Surgery, Long School of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, TX., Shih M; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX., Yi J; Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO., Gupta R; Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO., Loa J; Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia., Robinson DA; Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia., Gombert A; Department of Vascular Surgery, European Vascular Center Aachen Maastricht, RWTH, University Hospital Aachen, Aachen, Germany., Doukas P; Department of Vascular Surgery, European Vascular Center Aachen Maastricht, RWTH, University Hospital Aachen, Aachen, Germany., de Caridi G; Division of Vascular and Endovascular Surgery, Department of Biomorf, University of Messina, Messina, Italy., Benedetto F; Division of Vascular and Endovascular Surgery, Department of Biomorf, University of Messina, Messina, Italy., Wittgen CM; Division of Vascular Surgery, Department of Surgery, St. Louis University, St. Louis, MO., Smeds MR; Division of Vascular Surgery, Department of Surgery, St. Louis University, St. Louis, MO., Sumpio BE; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT., Harris S; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT., Szeberin Z; Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary., Pomozi E; Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary., Stilo F; Division of Vascular Surgery, Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy., Montelione N; Division of Vascular Surgery, Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy., Mouawad NJ; Division of Vascular and Endovascular Surgery, Department of Surgery, McLaren Health System, Bay City, MI., Lawrence P; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA., Dua A; Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Jazyk:	angličtina
Zdroj:	Journal of vascular surgery [J Vasc Surg] 2023 Feb; Vol. 77 (2), pp. 567-577.e2. Date of Electronic Publication: 2022 Oct 26.
DOI:	10.1016/j.jvs.2022.10.022
Abstrakt:	Objective: Prior research on median arcuate ligament syndrome has been limited to institutional case series, making the optimal approach to median arcuate ligament release (MALR) and resulting outcomes unclear. In the present study, we compared the outcomes of different approaches to MALR and determined the predictors of long-term treatment failure. Methods: The Vascular Low Frequency Disease Consortium is an international, multi-institutional research consortium. Data on open, laparoscopic, and robotic MALR performed from 2000 to 2020 were gathered. The primary outcome was treatment failure, defined as no improvement in median arcuate ligament syndrome symptoms after MALR or symptom recurrence between MALR and the last clinical follow-up. Results: For 516 patients treated at 24 institutions, open, laparoscopic, and robotic MALR had been performed in 227 (44.0%), 235 (45.5%), and 54 (10.5%) patients, respectively. Perioperative complications (ileus, cardiac, and wound complications; readmissions; unplanned procedures) occurred in 19.2% (open, 30.0%; laparoscopic, 8.9%; robotic, 18.5%; P < .001). The median follow-up was 1.59 years (interquartile range, 0.38-4.35 years). For the 488 patients with follow-up data available, 287 (58.8%) had had full relief, 119 (24.4%) had had partial relief, and 82 (16.8%) had derived no benefit from MALR. The 1- and 3-year freedom from treatment failure for the overall cohort was 63.8% (95% confidence interval [CI], 59.0%-68.3%) and 51.9% (95% CI, 46.1%-57.3%), respectively. The factors associated with an increased hazard of treatment failure on multivariable analysis included robotic MALR (hazard ratio [HR], 1.73; 95% CI, 1.16-2.59; P = .007), a history of gastroparesis (HR, 1.83; 95% CI, 1.09-3.09; P = .023), abdominal cancer (HR, 10.3; 95% CI, 3.06-34.6; P < .001), dysphagia and/or odynophagia (HR, 2.44; 95% CI, 1.27-4.69; P = .008), no relief from a celiac plexus block (HR, 2.18; 95% CI, 1.00-4.72; P = .049), and an increasing number of preoperative pain locations (HR, 1.12 per location; 95% CI, 1.00-1.25; P = .042). The factors associated with a lower hazard included increasing age (HR, 0.99 per increasing year; 95% CI, 0.98-1.0; P = .012) and an increasing number of preoperative diagnostic gastrointestinal studies (HR, 0.84 per study; 95% CI, 0.74-0.96; P = .012) Open and laparoscopic MALR resulted in similar long-term freedom from treatment failure. No radiographic parameters were associated with differences in treatment failure. Conclusions: No difference was found in long-term failure after open vs laparoscopic MALR; however, open release was associated with higher perioperative morbidity. These results support the use of a preoperative celiac plexus block to aid in patient selection. Operative candidates for MALR should be counseled regarding the factors associated with treatment failure and the relatively high overall rate of treatment failure. (Copyright © 2022 Society for Vascular Surgery. All rights reserved.)
Databáze:	MEDLINE
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