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Median arcuate ligament

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
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
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
Tom Hughes, Nikolaos A Chatzizacharias, James Richards, Simon Harper
INTRODUCTION: Inferior pancreatico-duodenal artery (IPDA) aneurysms are very rare and commonly associated with coeliac axis stenosis or occlusion due to atherosclerosis, thrombosis or median arcuate ligament syndrome. We present a case of a surgical repair of an IPDA aneurysm with the use of a supra-coeliac aorto-hepatic bypass with a polytetrafluoroethylene (PTFE) graft, following a failed initial attempt at an endovascular repair. PRESENTATION: A 75 year old female, who was under investigation for night sweats, was referred to our team with an incidental finding of a 19mm fusiform IPDA aneurysm...
September 26, 2016: International Journal of Surgery Case Reports
Hyeong Min Park, Seung Duk Lee, Eung Chang Lee, In Joon Lee, Sung-Sik Han, Hyun Boem Kim, Seoung Hoon Kim, Soon-Ae Lee, Sang-Jae Park
We describe 2 cases of patients with loss of hepatic arterial flow during surgery for pancreatic head cancer due to celiac stenosis caused by median arcuate ligament compression. The first case underwent pylorus-resecting pancreatoduodenectomy for pancreatic head cancer. After resection of the gastroduodenal artery, flow in the common hepatic artery disappeared, and celiac axis stenosis was identified. Interventional stent insertion was attempted, however, it failed due to the acute angle of the celiac orifice (os)...
September 2016: Annals of Surgical Treatment and Research
Kevin Cheng, Adam Doyle, Dean C Spilias, Kenneth K Lau
The median arcuate ligament syndrome is a rare disorder characterised by postprandial intestinal angina caused by compression of the coeliac artery by the median arcuate ligament. To date, the diagnosis and treatment of median arcuate ligament syndrome has remained controversial. To our knowledge, this is the first reported case of coeliac artery compression demonstrated on the four-dimensional wide-area detector CT angiogram.
September 7, 2016: Journal of Medical Imaging and Radiation Oncology
Kevin O'Brien, Hector Ferral
The median arcuate ligament (MAL) can rarely compress both the celiac axis and superior mesenteric artery. We present a case of a 70-year male who presented with isolated episodes of upper abdominal pain and diarrhea associated with sweats and nausea. Angiography images demonstrated complete occlusion of the celiac axis and compression of the superior mesenteric artery during the expiration phases. The celiac axis was reconstituted distal to its origin by a patent Arc of Buhler. Other reported cases of multivessel MALs have produced severe symptoms in young adults requiring surgical and/or endovascular intervention...
September 2016: Radiology case reports
Hélène Wattez, Teresa Martin-Gonzalez, Benjamin Lopez, Rafaëlle Spear, Rachel E Clough, Adrien Hertault, Jonathan Sobocinski, Stéphan Haulon
BACKGROUND: Endovascular repair of aortic aneurysms involving the visceral segment of the aorta often requires placement of a covered bridging stent in the celiac axis (CA). The median arcuate ligament (MAL) is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. The ligament may compress and distort the celiac artery and result in difficult cannulation, or stenosis and occlusion of the vessel. This study evaluated the influence of the MAL compression on the technical success and the patency of the celiac artery after branched and fenestrated endovascular aortic repair...
August 30, 2016: Journal of Vascular Surgery
Agata Arazińska, Michał Polguj, Andrzej Wojciechowski, Łukasz Trębiński, Ludomir Stefańczyk
PURPOSE: Median arcuate ligament syndrome (MALS) is a pathologic entity that can affect the celiac axis. Due to the extensive collateral network of mesenteric circulation, stenosis of one mesenteric artery does not lead to significant symptoms. The purpose of this study was to describe multidetector computed tomography (MDCT) angiography findings of celiac artery entrapment by the median arcuate ligament and determine those patients with high risks of ischemic complications. MATERIALS AND METHODS: From January 2012 to March 2016, 103 patients with celiac artery (CA) compression by median arcuate ligament were detected...
August 25, 2016: Clinical Anatomy
Ashley Prosper, Farhood Saremi
This case report demonstrates development and progressive enlargement of multiple pancreaticoduodenal arcade pseudoaneurysms using CT angiographies over a period of 5 weeks after abdominal trauma. The mechanism of pseudoaneurysm formation, as shown by serial imaging, attributed to preexisting celiac axis stenosis by the median arcuate ligament, post traumatic celiac artery dissection, and secondary occlusion of proper hepatic artery resulting in elevation of pressure and flow in the pancreaticocduodenal arcade and rupture of small arterial branches...
July 14, 2016: Annals of Vascular Surgery
Grace Zee Mak, Amanda R Lucchetti, Tina Drossos, Ellen E Fitzsimmons-Craft, Erin C Accurso, Colleen Stiles-Shields, Erika A Newman, Christopher L Skelly
Chronic abdominal pain (CAP) occurs in children and adolescents with a reported prevalence of 4% to 41% with significant direct and indirect costs to the child, family, and society. Median arcuate ligament syndrome (MALS) is a vascular compression syndrome of the celiac artery that may cause symptoms of epigastric pain and weight loss and is a frequently overlooked cause of CAP in the pediatric population. We have observed that the psychosocial presentation of patients with MALS is notable for various psychiatric comorbidities...
July 1, 2016: Pediatric Annals
Si-Yuan Yao, Shintaro Yagi, Hiroyuki Ueda
Postoperative celiac artery stenosis (CAS) rarely occurs in the absence of vascular injury or pseudoaneurysm after pancreatoduodenectomy (PD). Because of its low incidence, the optimal treatment for non-traumatic postoperative CAS is unknown. Here, we show a case of CAS possibly due to exacerbated median arcuate ligament compression after PD. The purpose of this report is to describe this rare complication and its successful endovascular treatment with review of literatures.
2016: Annals of Vascular Diseases
Naoki Notani, Masashi Miyazaki, Toyomi Yoshiiwa, Toshinobu Ishihara, Hiroshi Tsumura
PURPOSE: To describe the first case of a patient who developed acute celiac artery compression syndrome (ACACS) after extensive correction of sagittal balance on an adult spinal deformity. METHODS: A 77-year-old woman presented with low back pain and spinal kyphosis deformity. We performed a two-stage correction with extreme lateral interbody fusion (XLIF), and her lumbar lordosis improved from -47° to 53°. However, after surgery, she experienced frequent vomiting and diarrhea...
June 23, 2016: European Spine Journal
Parthasarathy Ramakrishnan, Biswajit Deuri, M S S Keerthi, Subrahmaneswara Babu Naidu, Rajapandian Subbaiah, Praveen Raj, Senthilnathan Palanisamy, Palanivelu Chinnusamy
Median arcuate ligament (MAL) syndrome is an uncommon condition caused by the external compression of the celiac trunk by the median arcuate ligament. In the current era of technological advancement, this syndrome may be corrected through the laparoscopic approach. We report two patients who were diagnosed as MAL syndrome and underwent laparoscopic division of MAL fibers at our institute. Both the patients improved symptomatically following the procedure and were discharged on the fourth post-operative day...
April 2016: Indian Journal of Surgery
Jeffrey N Harr, Ivy N Haskins, Fred Brody
BACKGROUND: Exercise-related transient abdominal pain (ETAP) is a common entity in young athletes. Most occurrences are due to a "cramp" or "stitch," but an uncommon, and often overlooked, etiology of ETAP is median arcuate ligament syndrome (MALS). The initial presentation of MALS typically includes postprandial nausea, bloating, abdominal pain, and diarrhea, but in athletes, the initial presentation may be ETAP. METHODS: We present a case series of three athletes who presented with exercise-related transient abdominal pain and were ultimately diagnosed and treated for MALS...
May 13, 2016: Surgical Endoscopy
Akihiko Sakatani, Yoshinori Doi, Toshiaki Kitayama, Takaaki Matsuda, Yasutaka Sasai, Naohiro Nishida, Megumi Sakamoto, Naoto Uenoyama, Kazuo Kinoshita
Pancreaticoduodenal artery aneurysms are a rare type of visceral artery aneurysm, whose rupture is associated with high mortality. These aneurysms are of particular interest because local haemodynamic change caused by coeliac artery obstruction plays an important role in their development. However, the pathophysiological mechanism of coeliac artery obstruction is not completely understood. Pressure from the median arcuate ligament is most frequently reported cause. Although it is well-known that stenosis or occlusion of the visceral vessels may be caused by aortic syndrome, reports of pancreaticoduodenal artery aneurysm associated with coeliac artery occlusion due to aortic syndrome are extremely rare...
April 28, 2016: World Journal of Gastroenterology: WJG
Ga-Young Suh, Gilwoo Choi, Robert J Herfkens, Ronald L Dalman, Christopher P Cheng
BACKGROUND: Visceral arteries are commonly involved in endovascular repair of complex abdominal aortic aneurysms (AAAs). To improve repair techniques and reduce long-term complications involving visceral arteries, it is crucial to understand in vivo arterial geometry and the deformations due to visceral organ movement with respiration. This study quantifies deformation of the celiac, superior mesenteric (SMA), and renal arteries during respiration and correlates the deformations with diaphragmatic excursion...
July 2016: Annals of Vascular Surgery
F H Ng, Ophelia K H Wai, Agnes W Y Wong, S M Yu
No abstract text is available yet for this article.
April 2016: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
P Štádler, L Dvořáček, P Vitásek, P Matouš
BACKGROUND: The aim of this study was to evaluate the clinical experience with 310 robot assisted vascular procedures. The da Vinci system has been used by a variety of disciplines for laparoscopic procedures but the use of robots in vascular surgery is still relatively uncommon. METHODS: From November 2005 to May 2014, 310 robot assisted vascular operations were performed. Two hundred and twenty four patients were prospectively evaluated for occlusive disease, 61 patients for abdominal aortic aneurysm, four for a common iliac artery aneurysm, four for a splenic artery aneurysm, one for a internal mammary artery aneurysm, and after the unsuccessful endovascular treatment five for hybrid procedures, two patients for median arcuate ligament release and nine for endoleak II treatment post EVAR...
July 2016: European Journal of Vascular and Endovascular Surgery
Enrique Criado
Surgical revascularization for chronic or acute mesenteric ischemia is often technically challenging. In many instances, because of the presence of hostile abdominal conditions or the lack of adequate intra-abdominal arterial inflow sources, alternative surgical approaches that avoid the abdomen and use a more proximal source of arterial inflow are necessary. In these situations, a bypass from the descending or ascending thoracic aorta to the mesenteric vessels may be the only viable option. However, the standard thoracoabdominal approach for mesenteric revascularization carries an extensive surgical insult, and in some situations, this approach does not obviate hostile abdominal pathology...
May 2016: Annals of Vascular Surgery
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