Imperial College London
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DrTristanLane

Faculty of Medicine, Department of Surgery & Cancer

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 3311 7317tristan.lane Website

 
 
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Location

 

Remote or 4N12ANorth WingCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Goodall:2020:10.1016/j.jvs.2019.11.012,
author = {Goodall, R and Langridge, B and Onida, S and Ellis, M and Lane, T and Davies, AH},
doi = {10.1016/j.jvs.2019.11.012},
journal = {Journal of Vascular Surgery},
pages = {2170--2176},
title = {Median arcuate ligament syndrome},
url = {http://dx.doi.org/10.1016/j.jvs.2019.11.012},
volume = {71},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: Median arcuate ligament syndrome (MALS) describes the clinical presentation associated with direct compression of the celiac artery by the median arcuate ligament. The poorly understood pathophysiologic mechanism, variable symptom severity, and unpredictable response to treatment make MALS a controversial diagnosis. METHODS: This review summarizes the literature pertaining to the pathophysiologic mechanism, presentation, diagnosis, and management of MALS. A suggested diagnostic workup and treatment algorithm are presented. RESULTS: Individuals with MALS present with signs and symptoms of foregut ischemia, including exercise-induced or postprandial epigastric pain, nausea, vomiting, and weight loss. Consideration of MALS in patients' diagnostic workup is typically delayed. Currently, no group consensus agreement as to the diagnostic criteria for MALS exists; duplex ultrasound, angiography, and gastric exercise tonometry are used in different combinations and with varying diagnostic values throughout the literature. Surgical management involves decompression of the median arcuate ligament's constriction of the celiac artery; robotic, laparoscopic, endoscopic retroperitoneal, and open surgical intervention can provide effective symptom relief, but long-term follow-up data (>5 years) are lacking. Patients treated nonoperatively appear to have worse outcomes. CONCLUSIONS: MALS is an important clinical entity with significant impact on affected individuals. Presenting symptoms, patient demographics, and radiologic signs are generally consistent, as is the short-to medium-term (<5 years) response to surgical intervention. Future prospective studies should directly compare long-term symptomatic and quality of life outcomes after nonoperative management with outcomes after open, laparoscopic, endoscopic retroperitoneal, and robotic celiac artery decompression to enable the development of evidence-based guidelines for the management of MALS.
AU  - Goodall,R
AU  - Langridge,B
AU  - Onida,S
AU  - Ellis,M
AU  - Lane,T
AU  - Davies,AH
DO  - 10.1016/j.jvs.2019.11.012
EP  - 2176
PY  - 2020///
SN  - 0741-5214
SP  - 2170
TI  - Median arcuate ligament syndrome
T2  - Journal of Vascular Surgery
UR  - http://dx.doi.org/10.1016/j.jvs.2019.11.012
UR  - https://www.ncbi.nlm.nih.gov/pubmed/31882314
UR  - https://www.sciencedirect.com/science/article/abs/pii/S0741521419326424?via%3Dihub
UR  - http://hdl.handle.net/10044/1/76537
VL  - 71
ER  -
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