Neelima Katragunta, Nicholas Drahush, Larry R. Sprouse
University of Tennessee, Chattanooga, TN.
OBJECTIVES: Median Arcuate Ligament Syndrome (MALS) remains one of the most controversial disease entities in vascular surgery. Its rarity and doubts about its mere existence often lead to a delay in diagnosis and/or suboptimal management of the disease. As a regional center, we present our experience in selecting and managing these patients.
METHODS: A retrospective analysis of 27 patients that underwent surgical intervention for MALS between January 2006 to June 2012 was conducted to characterize patient demographics, presenting symptoms, method of selection and management and symptomatic relief.
RESULTS: The average age of the patient population was 54.8 years (range 18-76 years) and they were predominantly female (81%, 22 patients). Postprandial abdominal pain was the main symptom (93%), followed by nausea (85%), weight loss (85%) and diarrhea (37%). An inspiratory/expiratory arteriogram was performed in 26 (96%) patients prior to surgery in order to confirm the diagnosis. All patients underwent open division of median arcuate ligament and an additional revascularization procedure (celiac artery patch angioplasty in 15, arterial bypass in 11 and endarterectomy in 1 patient). Symptomatic relief was seen in 23 (85%) of patients at 6 month follow-up. Late recurrence of symptoms was seen in 5 (18.5%) patients. Of the 5 (18.5%) patients that required re-intervention, only 1 required an open surgical repair. Complications were seen in 4 (14.8%) patients (wound infection, hernia, pancreatitis, and venous thromboembolism).
CONCLUSIONS: With careful patient selection and appropriate management, MALS can be managed with satisfactory outcomes. In our experience, open surgical release of the median arcuate ligament, along with arterial reconstruction is key to restoring adequate flow and for symptomatic relief. As our experience has evolved over years, arterial bypass has become our preferred method of arterial reconstruction.
AUTHOR DISCLOSURES: N. Drahush: Nothing to disclose; N. Katragunta: Nothing to disclose; L. R. Sprouse: Nothing to disclose.
Posted April 2013