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Median arcuate ligament

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https://www.readbyqxmd.com/read/28535930/ruptured-pancreaticoduodenal-artery-aneurysm-due-to-a-median-arcuate-ligament-treated-solely-by-revascularization-of-the-celiac-trunk
#1
Lucie Salomon du Mont, Fanny Lorandon, Julien Behr, Betty Leclerc, Emilie Ducroux, Simon Rinckenbach
Pancreaticoduodenal artery aneurysms (PDAA) are rare, but rupture can occur at any time regardless of the size. We describe here the case of 53-year-old woman who presented wit a ruptured PDAA associated with compression of the celiac trunk by the median arcuate ligament. We first performed revascularization of the celiac trunk without intervening on the PDAA, because of surgically hostile conditions. We observed complete regression of the PDAA, probably due to the dramatic decrease in inflow to the PDAA, thanks to the revascularization procedure...
May 20, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28493483/preoperative-imaging-and-prediction-of-oesophageal-conduit-necrosis-after-oesophagectomy-for-cancer
#2
P Lainas, D Fuks, S Gaujoux, Z Machroub, A Fregeville, T Perniceni, F Mal, B Dousset, B Gayet
BACKGROUND: Oesophageal conduit necrosis following oesophagectomy is a rare but life-threatening complication. The present study aimed to assess the impact of coeliac axis stenosis on outcomes after oesophagectomy for cancer. METHODS: The study included consecutive patients who had an Ivor Lewis procedure with curative intent for middle- and lower-third oesophageal cancer at two tertiary referral centres. All patients underwent preoperative multidetector CT with arterial phase to detect coeliac axis stenosis...
May 11, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28473083/acr-appropriateness-criteria-%C3%A2-radiologic-management-of-mesenteric-ischemia
#3
Nicholas Fidelman, Ali F AbuRahma, Brooks D Cash, Baljendra S Kapoor, M-Grace Knuttinen, Jeet Minocha, Paul J Rochon, Colette M Shaw, Charles E Ray, Jonathan M Lorenz
Mesenteric vascular insufficiency is a serious medical condition that may lead to bowel infarction, morbidity, and mortality that may approach 50%. Recommended therapy for acute mesenteric ischemia includes aspiration embolectomy, transcatheter thrombolysis, and angioplasty with or without stenting for the treatment of underlying arterial stenosis. Nonocclusive mesenteric ischemia may respond to transarterial infusion of vasodilators such as nitroglycerin, papaverine, glucagon, and prostaglandin E1. Recommended therapy for chronic mesenteric ischemia includes angioplasty with or without stent placement and, if an endovascular approach is not possible, surgical bypass or endarterectomy...
May 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28462569/exercise-induced-median-arcuate-ligament-syndrome-in-athletes-case-series
#4
Yasmin Grant, Sarah Onida, Brahman Dharmarajah, Emma B Davies, Alun H Davies
The median arcuate ligament (MAL) is a fibrous arch connecting the right and left diaphragmatic crura; this usually lies superior to the origin of the coeliac axis. Occasionally, the ligament crosses anterior to the aorta, at the level of the coeliac trunk; leading to mechanical compression of the coeliac artery, resulting in the clinical condition of MAL syndrome (MALS). Symptomatic patients characteristically present with post-prandial pain associated with unintentional weight loss, nausea, vomiting and diarrhoea...
April 28, 2017: Journal of Sports Medicine and Physical Fitness
https://www.readbyqxmd.com/read/28395788/diagnosis-and-treatment-of-chronic-mesenteric-ischemia-an-update
#5
REVIEW
Jeroen J Kolkman, Robert H Geelkerken
Although the prevalence of mesenteric artery stenoses (MAS) is high, symptomatic chronic mesenteric ischemia (CMI) is rare. The collateral network in the mesenteric circulation, a remnant of the extensive embryonal vascular network, serves to prevent most cases of ischemia. This explains the high incidence of MAS and relative rarity of cases of CMI. The number of affected vessels is the major determinant in CMI development. Most subjects with single vessel mesenteric stenosis do not develop ischemic complaints...
February 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28381781/a-case-report-of-duodenal-obstruction-due-to-retroperitoneal-bleeding-after-the-rupture-of-a-lower-pancreaticoduodenal-artery-aneurysm
#6
Nobuhiro Takeuchi, Kazumasa Emori, Yusuke Nomura
We report a case of a patient with duodenal obstruction due to retroperitoneal bleeding after the rupture of a lower pancreaticoduodenal artery aneurysm. An 80-year-old female was admitted to our hospital because of nausea and vomiting. During hospitalization, she developed hemorrhagic shock. Enhanced computed tomography revealed retroperitoneal bleeding. Abdominal angiography revealed an 8-mm aneurysm of the lower pancreaticoduodenal artery, stenosis at the trunk of the celiac artery, and increased blood flow through the pancreaticoduodenal arcades from the superior mesenteric artery...
2017: Nihon Shokakibyo Gakkai Zasshi, the Japanese Journal of Gastro-enterology
https://www.readbyqxmd.com/read/28302657/vascular-challenges-from-pancreatoduodenectomy-in-the-setting-of-coeliac-artery-stenosis
#7
Joal D Beane, Roderich E Schwarz
Coeliac artery stenosis due to median arcuate ligament compression or atherosclerotic disease is a frequently unrecognised challenge to recovery after pancreatoduodenectomy. The described case illustrates management with intraoperative superior mesenteric artery to hepatic artery bypass graft that led to haemorrhagic challenges postoperatively but ultimately a good recovery. Aspects of preoperative diagnosis, preoperative intervention and intraoperative management options are reviewed. Surgeons need to possess these tools to prevent complications from coeliac artery stenosis when pancreatoduodenectomy is required...
March 16, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28286755/aneurysms-of-peripancreatic-arterial-arcades-coexisting-with-celiac-trunk-stenosis-or-occlusion-single-institution-experience
#8
Robert Antoniak, Laretta Grabowska-Derlatka, Ireneusz Nawrot, Andrzej Cieszanowski, Olgierd Rowiński
Introduction. True aneurysms of peripancreatic arterial arcades (PAAAs) are rare. Most of them coexist with celiac axis stenosis/occlusion due to median arcuate ligament (MAL) compression or atherosclerosis. The aim of this study was to evaluate the cause of celiac axis lesion and characterize the anatomy of the aneurysms. These findings may have important management implications. Material and Methods. A retrospective analysis of 15 patients with true PAAAs was performed. The diagnosis was established by contrast-enhanced CT, using a 64-MDCT scanner...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28223737/pancreaticoduodenectomy-secondary-stenting-of-the-celiac-trunk-after-inefficient-median-arcuate-ligament-release-and-reoperation-as-an-alternative-to-simultaneous-hepatic-artery-reconstruction
#9
Théophile Guilbaud, Jacques Ewald, Olivier Turrini, Jean Robert Delpero
In patients undergoing pancreaticoduodenectomy (PD), unrecognized hemodynamically significant celiac axis (CA) stenosis impairs hepatic arterial flow by suppressing the collateral pathways supplying arterial flow from the superior mesenteric artery and leads to serious hepatobiliary complications due to liver and biliary ischemia, with a high rate of mortality. CA stenosis is usually due to an extrinsic compression by a previously asymptomatic median arcuate ligament (MAL). MAL is diagnosed by computerized tomography in about 10% of the candidates for PD, but only half are found to be hemodynamically significant during the gastroduodenal artery clamping test with Doppler assessment, which is mandatory before any resection...
February 7, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28124567/phase-contrast-mri-evaluation-of-haemodynamic-changes-induces-by-a-coeliac-axis-stenosis-in-the-gastroduodenal-artery
#10
Audrey Haquin, Monica Sigovan, Salim Si-Mohamed, Jean-Yves Mabrut, Anne-Frédérique Manichon, Melisa Bakir, Agnès Rode, Loïc Boussel
OBJECTIVE: To evaluate the correlation between the gastroduodenal artery (GDA) haemodynamic changes and the degree of coeliac axis (CA) stenosis using phase-contrast MRI. METHODS: The study was institutional review board approved, and written informed consent was obtained from patients included prospectively. A two-dimensional phase-contrast MRI was performed in 23 patients scheduled for a potential complex supramesocolic surgery, in a plane perpendicular to the GDA, during inspiration and expiration...
April 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/28050657/median-arcuate-ligament-syndrome-a-single-center-experience-with-23-patients
#11
Layla A Nasr, Walid G Faraj, Aghiad Al-Kutoubi, Mohamad Hamady, Mohamad Khalifeh, Ali Hallal, Hamzeh M Halawani, Joelle Wazen, Ali A Haydar
BACKGROUND: Median arcuate ligament syndrome (MALS) is a rare entity that occurs when the median arcuate ligament of the diaphragm is low-lying, causing a compression to the underlying celiac trunk. We reviewed the vascular changes associated with MALS in an effort to emphasize the seriousness of this disease and the complications that may result. METHODS: This is a retrospective descriptive analysis of 23 consecutive patients diagnosed with MALS between January 1, 2012 and December 31, 2015 at a tertiary medical center...
May 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28017582/outcomes-of-conservative-management-of-spontaneous-celiac-artery-dissection
#12
Akihiro Hosaka, Masaru Nemoto, Tetsuro Miyata
OBJECTIVE: Spontaneous celiac artery (CA) dissection without associated aortic dissection is a rare condition. Although this condition has been diagnosed more frequently with the advent of improved diagnostic imaging modalities, its pathogenesis and treatment strategy remain to be established. The present study examined the clinical features and outcomes of conservative management of this disease. METHODS: The study included 12 patients (10 men and two women) in whom spontaneous CA dissection was diagnosed between 2007 and 2015...
March 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27980769/median-arcuate-ligament-syndrome-case-presentation-and-video-illustrated-laparoscopic-management
#13
Antoine El Asmar, Ziad El Rassi
Laparoscopic release of the median arcuate ligament, to relieve symptomatic compression of the celiac trunk, is the ideal approach when performed in a specialized center, by a surgeon with the adequate experience in advanced laparoscopic surgery.
December 2016: Clinical Case Reports
https://www.readbyqxmd.com/read/27896401/sleeve-gastrectomy-combined-with-the-simplified-hill-repair-in-the-treatment-of-morbid-obesity-and-gastro-esophageal-reflux-disease-preliminary-results-in-14-patients
#14
Daniel Gero, Lara Ribeiro-Parenti, Konstantinos Arapis, Jean-Pierre Marmuse
BACKGROUND: Our aim is to report our initial experience with a novel technique which addresses morbid obesity and gastro-esophageal reflux disease (GERD) simultaneously by combination of laparoscopic sleeve gastrectomy (LSG) and simplified laparoscopic Hill repair (sLHR). METHODS: Retrospective analysis of LSG+sLHR patients >5 months postoperatively includes demographics, GERD status, proton-pump inhibitor (PPI) use, body mass index (BMI), excess BMI loss (EBMIL), complications and GERD-Health Related Quality of Life (GERD-HRQL) questionnaire...
April 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/27890893/successful-coil-embolization-of-an-aneurysm-in-the-arc-of-b%C3%A3-hler
#15
Fumie Sugihara, Satoru Murata, Fumio Uchiyama, Jun Watari, Hiroto Tajima, Shin-Ichiro Kumita
In the present report, we describe a case of a patient with an asymptomatic aneurysm in the arc of Bühler (AOB), which was successfully treated by transcatheter arterial embolization. The patient presented with severe stenosis of the celiac trunk, which was suspected to be due to median arcuate ligament syndrome. Arteriography of the superior mesenteric artery indicated a rapid stream in an aneurysm in the AOB. Hence, embolization was carefully performed using detachable coils and microcoils. An arteriography performed after embolization did not show any aneurysm, and the hepatic artery and splenic artery could be detected via the pancreatic arcade, originating from the superior mesenteric artery...
2016: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
https://www.readbyqxmd.com/read/27871496/the-presentation-and-management-of-aneurysms-of-the-pancreaticoduodenal-arcade
#16
Michael R Corey, Emel A Ergul, Richard P Cambria, Virendra I Patel, R Todd Lancaster, Christopher J Kwolek, Mark F Conrad
OBJECTIVE: Gastroduodenal artery aneurysms (GDAAs) and pancreaticoduodenal artery aneurysms (PDAAs) are uncommon lesions associated, however, with a significant risk of rupture. This study describes the clinical presentation, associated imaging findings, and operative strategies for these aneurysms. METHODS: The records of all patients with GDAAs or PDAAs identified through an institutional database by axial imaging between 1994 and 2014 were retrospectively reviewed...
December 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27864611/perioperative-hemodynamic-monitoring-of-common-hepatic-artery-for-endovascular-embolization-of-a-pancreaticoduodenal-arcade-aneurysm-with-celiac-stenosis
#17
Eisuke Shibata, Hidemasa Takao, Shiori Amemiya, Kuni Ohtomo
This report describes perioperative hemodynamic monitoring of the common hepatic artery (CHA) during endovascular treatment of a pancreaticoduodenal arcade aneurysm, in a patient with celiac artery stenosis caused by the median arcuate ligament. Pressure monitoring was performed as a safety measure against critical complications such as liver ischemia. As the aneurysm was located in the anterior pancreaticoduodenal artery (APDA) and the posterior pancreaticoduodenal artery (PPDA) was small in caliber, the patient was considered to be at a high risk of liver ischemia...
March 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/27777480/abdominal-vascular-syndromes-characteristic-imaging-findings
#18
Leandro Cardarelli-Leite, Fernanda Garozzo Velloni, Priscila Silveira Salvadori, Marcelo Delboni Lemos, Giuseppe D'Ippolito
Abdominal vascular syndromes are rare diseases. Although such syndromes vary widely in terms of symptoms and etiologies, certain imaging findings are characteristic. Depending on their etiology, they can be categorized as congenital-including blue rubber bleb nevus syndrome, Klippel-Trenaunay syndrome, and hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome)-or compressive-including "nutcracker" syndrome, median arcuate ligament syndrome, Cockett syndrome (also known as May-Thurner syndrome), and superior mesenteric artery syndrome...
July 2016: Radiologia Brasileira
https://www.readbyqxmd.com/read/27744644/acute-median-arcuate-ligament-syndrome-after-pancreaticoduodenectomy
#19
Ilhan Karabicak, Sohei Satoi, Hiroaki Yanagimoto, Tomohisa Yamamoto, Satoshi Hirooka, So Yamaki, Hisashi Kosaka, Masaya Kotsuka, Kentoro Inoue, Yoichi Matsui, Masanori Kon
Median arcuate ligament syndrome (MALS) has been reported in 2-7.6 % of patients undergoing pancreaticoduodenectomy (PD). Most of the reported cases of MALS have been diagnosed perioperatively and treated radiologically or surgically before or during PD. MALS can have an acute postoperative onset after PD even if all preoperative and intraoperative evaluations are normal particularly in young patients.In this report, we present a second case of severe hepatic cytolysis secondary to MALS that developed acutely and the first patient who required acute division of the median arcuate ligament after PD...
December 2016: Surgical Case Reports
https://www.readbyqxmd.com/read/27738465/pancreatic-arcade-artery-aneurysm-a-rare-complication-after-replacement-of-thoracoabdominal-aortic-aneurysm
#20
Mitsuru Sato, Shunsuke Kawamoto, Yoshikatsu Saiki
Aneurysm in the pancreatic arcade artery is an uncommon event, and is usually associated with the condition of median arcuate ligament syndrome. The stenosis at the base of the celiac axis has been presumed to be attributable to a relative increase in flow and pressure within the pancreatic arcade, resulting in subsequent development of the aneurysm. We, herein, present a rare case with rapid development of a pancreatic arcade artery aneurysm immediately after the replacement of a thoracoabdominal aortic aneurysm...
2016: Annals of Vascular Diseases
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