Median arcuate ligament syndrome
| Autor: | Richard Goodall, Tristan R A Lane, Alun H. Davies, Benjamin Langridge, Sarah Onida, M. Ellis |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Nausea Constriction Pathologic 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Celiac artery compression Median Arcuate Ligament Syndrome Celiac artery Celiac Artery medicine.artery parasitic diseases Mesenteric Vascular Occlusion medicine Humans 030212 general & internal medicine Splanchnic Circulation 11 Medical and Health Sciences Vascular Patency Ligaments medicine.diagnostic_test business.industry Median arcuate ligament medicine.disease Decompression Surgical Surgery medicine.anatomical_structure Treatment Outcome Cardiovascular System & Hematology Mesenteric ischemia Mesenteric Ischemia Angiography Vomiting lipids (amino acids peptides and proteins) medicine.symptom Cardiology and Cardiovascular Medicine business Median arcuate ligament syndrome |
| Zdroj: | Journal of vascular surgery. 71(6) |
| ISSN: | 1097-6809 |
| Popis: | BACKGROUND: Median arcuate ligament syndrome (MALS) describes the clinical presentation associated with direct compression of the celiac artery by the median arcuate ligament. The poorly understood pathophysiologic mechanism, variable symptom severity, and unpredictable response to treatment make MALS a controversial diagnosis. METHODS: This review summarizes the literature pertaining to the pathophysiologic mechanism, presentation, diagnosis, and management of MALS. A suggested diagnostic workup and treatment algorithm are presented. RESULTS: Individuals with MALS present with signs and symptoms of foregut ischemia, including exercise-induced or postprandial epigastric pain, nausea, vomiting, and weight loss. Consideration of MALS in patients' diagnostic workup is typically delayed. Currently, no group consensus agreement as to the diagnostic criteria for MALS exists; duplex ultrasound, angiography, and gastric exercise tonometry are used in different combinations and with varying diagnostic values throughout the literature. Surgical management involves decompression of the median arcuate ligament's constriction of the celiac artery; robotic, laparoscopic, endoscopic retroperitoneal, and open surgical intervention can provide effective symptom relief, but long-term follow-up data (>5 years) are lacking. Patients treated nonoperatively appear to have worse outcomes. CONCLUSIONS: MALS is an important clinical entity with significant impact on affected individuals. Presenting symptoms, patient demographics, and radiologic signs are generally consistent, as is the short-to medium-term ( |
| Databáze: | OpenAIRE |
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