Celiac compression syndrome: tailored therapy based on intraoperative findings

Abstract

Background: The role of surgical treatment for the relatively rare celiac artery compression syndrome remains controversial. We used a tailored operative approach based on intraoperative findings.

Study design: We retrospectively reviewed operative and follow-up data from the seven patients at our institution who underwent tailored operative intervention for celiac artery compression syndrome during a 15-year period.

Results: In all patients, decompression of the celiac axis was accomplished by division of the sympathetic neural fibers and the median arcuate ligament. In five cases in which intraoperative evaluation demonstrated compromised celiac artery flow after decompression, revascularization was also performed: three patients underwent an aortoceliac bypass, which was performed with a polytetrafluoroethylene graft in two cases and a vein graft in one case; the fourth patient had an angioplasty using a knitted polyester fiber patch, and the fifth patient underwent aortic reimplantation of the celiac artery. The tailored operative approach (decompression alone or with revascularization) for celiac artery compression syndrome, determined on the basis of intraoperative findings, provided complete (immediate and long-term) relief of preoperative symptoms in all seven patients.

Conclusions: The tailored approach to operative intervention for celiac artery compression syndrome, which is based on individual operative findings, offers patients an excellent chance for immediate and long-term freedom from symptoms.