Median arcuate ligament syndrome

  • Audra A. DuncanEmail author

Opinion statement

Median arcuate ligament syndrome (MALS) can cause a range of symptoms, including abdominal pain, nausea, vomiting, and weight loss. Because all patients have some degree of celiac artery compression by the median arcuate ligament (MAL), it may be difficult to discern which patients have a pathologic compression. Based on the multiple theories of MALS etiology, it is unlikely that we know the true cause of this syndrome. In fact, there are many physicians who question the validity of the diagnosis of MALS. Before offering intervention for MALS, a thorough gastrointestinal evaluation should be performed, including consideration of diagnostic temporary percutaneous celiac ganglion block. Patients who are on chronic narcotics preoperatively have a lower likelihood of postoperative symptom relief and therefore should be evaluated by a pain specialist preoperatively. The most reliable treatment comprises open surgical treatment with division of the MAL, removal of surrounding celiac ganglion, evaluation of the celiac artery with pressure measurements or ultrasound, and celiac artery reconstruction if indicated. Laparoscopic and endovascular interventions are novel treatments and may be considered in select patients who cannot undergo an open surgical procedure.


Mesenteric Ischemia Celiac Artery Chronic Mesenteric Ischemia Celiac Ganglion Median Arcuate Ligament 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Harjola PT: A rare obstruction of the celiac artery. Ann Chir Gynaecol Fenn 1963, 52:547–550.PubMedGoogle Scholar
  2. 2.
    Dumbar JD, Molnar W, Bemon F, Marable S: Compression of the celiac trunk and abdominal angina. Am J Roentgenol Radium Ther Nucl Med 1965, 45:731–744.Google Scholar
  3. 3.
    Bech FR: Celiac artery compression syndromes. Surg Clin N Am 1997, 77:409–424.PubMedCrossRefGoogle Scholar
  4. 4.
    Reilly LM, Ammar AD, Stoney RJ, Ehrenfeld WK: Late results following operative repair for celiac artery compression syndrome. J Vasc Surg 1985, 2:79–91.PubMedCrossRefGoogle Scholar
  5. 5.
    Brandt LJ, Boely SJ: Celiac axis compression syndrome: a critical review. Dig Dis Sci 1978, 23:633–640.CrossRefGoogle Scholar
  6. 6.
    Tribble CG, Harman PK, Mentzer RM: Celiac artery compression syndrome: report of a case and review of the literature. Vasc Surg 1986, 20:120–129.Google Scholar
  7. 7.
    Cusati DA, Noel AA, Gloviczki P, et al.: Median arcuate ligament syndrome: a 20-year experience of surgical treatment. Presented at the Annual Meeting of the Society for Vascular Surgery. Philadelphia, PA; June 1–4, 2006.Google Scholar
  8. 8.
    Balaban DH, Chen J, Lin Z, et al.: Median arcuate ligament syndrome: a possible cause of idiopathic gastroparesis. Am J Gastroenterol 1997, 92:519–523.PubMedGoogle Scholar
  9. 9.
    Desmond CP, Roberts SK: Exercise-related abdominal pain as a manifestation of the median arcuate ligament syndrome. Scand J Gastroenterol 2004, 39:1310–1313.PubMedCrossRefGoogle Scholar
  10. 10.
    Akatsu T, Hayashi S, Yamane T, et al.: Emergency embolization of a ruptured pancreaticoduodenal artery aneurysm associated with the median arcuate ligament syndrome. J Gastroenterol Hepatol 2004, 19:482–483.PubMedCrossRefGoogle Scholar
  11. 11.
    Horton KM, Talamini MA, Fishman EK: Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics 2005, 25:1177–1182.PubMedCrossRefGoogle Scholar
  12. 12.
    Kalra M, Panneton JM, Hofer JM, Andrews JC: Aneurysm and stenosis of the celiomesenteric trunk: a rare anomaly. J Vasc Surg 2003, 37:679–682.PubMedCrossRefGoogle Scholar
  13. 13.
    Lee MJ, Mueller PR, vanSonnenberg E, et al.: CT-guided celiac ganglion block with alcohol. AJR Am J Roentgenol 1993, 161:633–636.PubMedGoogle Scholar
  14. 14.
    Takach TJ, Livesay JJ, Reul GL Jr, Cooley DA: Celiac compression syndrome: tailored therapy based on intraoperative findings. J Am Coll Surg 1996, 183:606–610.PubMedGoogle Scholar
  15. 15.
    Roayaie S, Jossart G, Gitlitz D, et al.: Laparoscopic release of celiac artery compression syndrome facilitated by laparoscopic ultrasound scanning to confirm restoration of flow. J Vasc Surg 2000, 32:814–817.PubMedCrossRefGoogle Scholar
  16. 16.
    Carbonell AM, Kercher KW, Heniford BT, Matthews BD: Laparoscopic management of median arcuate ligament syndrome. Surg Endosc 2005, 19:729.PubMedCrossRefGoogle Scholar
  17. 17.
    Dordogne L, Tshomba Y, Giacomelli M, et al.: Celiac artery compression syndrome: successful laparoscopic treatment—a case report. Vasc Endovasc Surg 2002, 36:317–321.CrossRefGoogle Scholar
  18. 18.
    Saddekni S, Sniderman KW, Hilton S, Sos TA: Percutaneous transluminal angioplasty of nonatherosclerotic lesions. AJR Am J Roentgenol 1980, 135:975–982.PubMedGoogle Scholar
  19. 19.
    Matsumoto AH, Tegtmeyer CJ, Fitzcharles EK, et al.: Percutaneous transluminal angioplasty of visceral arterial stenoses: results and long-term clinical follow-up. J Vasc Interv Radiol 1995, 6:165–174.PubMedCrossRefGoogle Scholar
  20. 20.
    Matsumoto AH, Angle JF, Spinosa DJ, et al.: Percutaneous transluminal angioplasty and stenting in the treatment of chronic mesenteric ischemia: results and longterm followup. J Am Coll Surg 2002, 194(1 Suppl):S22–S31.PubMedCrossRefGoogle Scholar
  21. 21.
    Cina CS, Safar H: Successful treatment of recurrent celiac axis compression syndrome. A case report. Panminerva Med 2002, 44:69–72.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Division of Vascular SurgeryMayo Clinic RochesterRochesterUSA

Personalised recommendations