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Detailed anatomy and procedure of celiac artery decompression in median arcuate ligament syndrome

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Abstract

Purpose

Median arcuate ligament (MAL) syndrome is a clinical syndrome caused by the compression of the celiac artery (CA) by the MAL. This study aimed to present the detailed anatomy and a step-by-step procedure of CA decompression for MAL syndrome.

Methods

The CA decompression procedure involves exposing the diaphragmatic crura and aorta, taping the left gastric artery, and dividing the compressive tissues. The MAL and ganglionic tissue, which form a broad band with multiple layers overlying the CA, comprise the compressive tissues. Therefore, the compressive tissues overlying the CA are encircled and divided one by one until the CA stenosis is released. CA decompression is confirmed with intraoperative duplex ultrasonography of the CA, with a return to normal peak systolic velocities without variation between deep inspiration and expiration.

Conclusion

This report presents the detailed anatomy and procedural steps for CA decompression in MAL syndrome.

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Abbreviations

CA:

Celiac artery

CHA:

Common hepatic artery

IPA:

Inferior phrenic artery

LGA:

Left gastric artery

MAL:

Median arcuate ligament

References

  1. Kim EN, Lamb K, Relles D, Moudgill N, DiMuzio PJ, Eisenberg JA (2016) Median arcuate ligament syndrome—review of this rare disease. JAMA Surg 151(5):471–477. https://doi.org/10.1001/jamasurg.2016.0002

    Article  PubMed  Google Scholar 

  2. Sgroi MD, Kabutey N-K, Krishnam M, Fujitani RM (2015) Pancreaticoduodenal artery aneurysms secondary to median arcuate ligament syndrome may not need celiac artery revascularization or ligament release. Ann Vasc Surg 29(1):122. e1–122. e7. https://doi.org/10.1016/j.avsg.2014.05.020

    Article  Google Scholar 

  3. Oikawa R, Ito K, Takemura N, Mihara F, Kokudo N (2020) Arterial communication around the pancreatic tail enabled division of the gastroduodenal artery during pancreaticoduodenectomy in patient with complete celiac artery occlusion: a case report. Surg Case Rep 6(1):29. https://doi.org/10.1186/s40792-020-0787-2

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cienfuegos JA, Estevez MG, Ruiz-Canela M, Pardo F, Diez-Caballero A, Vivas I, Bilbao JI, Martí-Cruchaga P, Zozaya G, Valentí V, Hernández-Lizoáin JL, Rotellar F (2018) Laparoscopic treatment of median arcuate ligament syndrome: analysis of long-term outcomes and predictive factors. J Gastrointest Surg 22(4):713–721. https://doi.org/10.1007/s11605-017-3635-3

    Article  PubMed  Google Scholar 

  5. Moore KL, Dalley AF (2017) Clinically oriented anatomy 8th edition. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  6. Jimenez JC, Harlander-Locke M, Dutson EP (2012) Open and laparoscopic treatment of median arcuate ligament syndrome. J Vasc Surg 56(3):869–873. https://doi.org/10.1016/j.jvs.2012.04.057

    Article  PubMed  Google Scholar 

  7. Loukas M, Hullett J, Wagner T (2005) Clinical anatomy of the inferior phrenic artery. Clin Anat 18(5):357–365. https://doi.org/10.1002/ca.20112

    Article  PubMed  Google Scholar 

  8. Vaziri K, Hungness ES, Pearson EG, Soper NJ (2009) Laparoscopic treatment of celiac artery compression syndrome: case series and review of current treatment modalities. J Gastrointest Surg 13(2):293–298. https://doi.org/10.1007/s11605-008-0702-9

    Article  PubMed  Google Scholar 

  9. Lipshutz B (1917) A composite study of the coeliac axis artery. Ann Surg 65(2):159–169. https://doi.org/10.1097/00000658-191702000-00006

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Harjola P (1963) A rare obstruction of the coeliac artery. Report of a case. Ann Chir Gynaecol Fenn 52:547–550

    CAS  PubMed  Google Scholar 

  11. Do MV, Smith TA, Bazan HA, Sternbergh W, Abbas AE, Richardson WS (2013) Laparoscopic versus robot-assisted surgery for median arcuate ligament syndrome. Surg Endosc 27(11):4060–4066. https://doi.org/10.1007/s00464-013-3061-x

    Article  PubMed  Google Scholar 

  12. Reilly LM, Ammar AD, Stoney RJ, Ehrenfeld WK (1985) Late results following operative repair for celiac artery compression syndrome. J Vasc Surg 2(1):79–91

    Article  CAS  Google Scholar 

  13. Kohn GP, Bitar RS, Farber MA, Marston WA, Overby DW, Farrell TM (2011) Treatment options and outcomes for celiac artery compression syndrome. Surg Innov 18(4):338–343. https://doi.org/10.1177/1553350610397383

    Article  PubMed  Google Scholar 

  14. Roseborough GS (2009) Laparoscopic management of celiac artery compression syndrome. J Vasc Surg 50(1):124–133. https://doi.org/10.1016/j.jvs.2008.12.078

    Article  PubMed  Google Scholar 

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Availability of data and material

The datasets analyzed during the current study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from the corresponding author on reasonable request.

Funding

Grants-in-Aid for Research from the National Center for Global Health and Medicine (30-1021 to N. T.).

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Authors and Affiliations

  1. Hepato-Biliary Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Kyoji Ito, Nobuyuki Takemura, Ryo Oikawa, Fuyuki Inagaki, Fuminori Mihara & Norihiro Kokudo

Authors
  1. Kyoji Ito
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  2. Nobuyuki Takemura
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  3. Ryo Oikawa
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  4. Fuyuki Inagaki
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  5. Fuminori Mihara
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  6. Norihiro Kokudo
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Contributions

KI and NT contributed to the conception and design of the study. All authors contributed to the acquisition and analysis of data. KI and NT were major contributors in writing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nobuyuki Takemura.

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Ethics approval and consent to participate

This article satisfied the consensus of the National Center for Global Health and Medicine Research Ethics Committee/Institutional Review Board.

Consent for publication

Informed consent for using intraoperative photographs was obtained from the patient presented in this article.

Conflict of interest

The authors declare no competing interests.

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Ito, K., Takemura, N., Oikawa, R. et al. Detailed anatomy and procedure of celiac artery decompression in median arcuate ligament syndrome. Langenbecks Arch Surg 406, 1717–1722 (2021). https://doi.org/10.1007/s00423-021-02195-9

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  • DOI: https://doi.org/10.1007/s00423-021-02195-9

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