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Review
. 2024 Sep 18;14(5):1911-1920.
doi: 10.3390/clinpract14050151.

Practice-Based Management Data of Consecutive Subjects Assessed for the Median Arcuate Ligament Syndrome at a Single Tertiary Institution

Stephanie Zbinden  1 , Gabor Forgo  1 , Nils Kucher  1 , Stefano Barco  1
Affiliations
Review

Practice-Based Management Data of Consecutive Subjects Assessed for the Median Arcuate Ligament Syndrome at a Single Tertiary Institution

Stephanie Zbinden et al. Clin Pract. .

Abstract

Background: The pathophysiology of median arcuate ligament syndrome (MALS) is poorly understood. The diagnostic process remains inadequately standardized, with an absence of precise criteria to guide therapeutic management.

Methods: We studied consecutive subjects referred to the Department of Angiology at the University Hospital of Zurich over the past 17 years due to suspected MALS. We focused on (1) the imaging criteria that led to diagnosis, notably the results of color duplex ultrasound and the consistency with different imaging tests; (2) the clinical consequences focusing on symptom resolution.

Results: We included 33 subjects; in 8 subjects (24.2%), the diagnosis of MALS was retained. The median expiration peak systolic velocity (PSV) on ultrasound was 3.05 (Q1; 2.1-Q3; 3.3). To confirm the sonographic results, either a CT or MRI was performed on all patients, with consistent findings confirming a significant stenosis. Seven patients underwent surgery, all involving arcuate ligament release. Four procedures were laparoscopic, one was via laparotomy, and two were robot-assisted. Additionally, two patients required angioplasty with stenting as a secondary intervention. Only two (28.6%) of the seven operated patients experienced a relief of symptoms. None experienced a relief of symptoms following secondary angioplasty, despite stent patency. The prevalence of psychiatric disorders was comparable between patients with retained and rejected diagnoses, 38% and 36%, respectively.

Conclusions: Our study confirmed sonography and CT/MRI consistency. However, most patients with MALS did not benefit from invasive treatment. The majority (83%) of patients without MALS were diagnosed with alternative conditions, mainly functional disorders.

Keywords: Dunbar syndrome; celiac artery compression syndrome; color duplex ultrasound; median arcuate ligament syndrome; vascular compression syndrome.

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Conflict of interest statement

The authors certify that there are no conflicts of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
Visual abstract showing a flowchart and our findings.
Figure 2
Figure 2
Color duplex ultrasound images showing (preoperative upper-left panel, postoperative upper-right panel) postoperative improvement in the PSV and EDV values from 305/203 cm/s to 226/72 cm/s. Digital subtraction angiography (lower-left panel) and magnetic resonance imaging (lower-right panel) showing a preoperative stenosis of the celiac artery (arrow) in a patient with MALS. PSV: peak systolic velocity; EDV: end-diastolic velocity.
Figure 3
Figure 3
Color duplex ultrasound images showing the improvement in postoperative PSV and EDV on expiration and inspiration in a patient with MALS (preoperative upper-left 305/135 cm/s and right 162/62 cm/s, postoperative middle-left 163/63 cm/s and right 146/62 cm/s). Computed tomography (lower panel) showing a preoperative stenosis of the celiac artery in the same patient. PSV: peak systolic velocity; EDV: end-diastolic velocity.
See this image and copyright information in PMC

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