Intraoperative measurement of pressure gradient in median arcuate ligament syndrome as a rationale for radical surgical approach
Result description
Background: Median arcuate ligament syndrome (MALS) describes clinical symptoms in patients with stenosis of the celiac artery due to external compression by the ligament. There is an ongoing debate, whether sole release of the median arcuate ligament warrants long-term relief of the symptoms. Materials and methods: Eight patients diagnosed with MALS underwent open surgical treatment beginning with the release of the ligament. Systemic pressure and pressure in the left gastric artery were measured before and after division of the median arcuate ligament and release of the celiac artery. In patients with persistent gradient above 15 mm Hg after the release a PTFE bypass was performed. Results: After the release, the pressure gradient decreased from 66 +- 19 to 48 +- 14 mm Hg (p = .001) and therefore in all patients either an aorto-celiac bypass (n = 6) or aorto-hepatic bypass (n = 2) was created. Consequently, the gradient decreased to 7 +- 2 mm Hg (p = .0001). One month postoperatively, three patients were free of symptoms and the rest reported relief of symptoms. Conclusions: Release of the celiac artery resulted in insufficient decrease of pressure gradient, which was achieved by bypassing the segment with favorable mid-term outcome. We believe that the effect of the release should always be assessed to decide on subsequent treatment.
Keywords
blood pressureentrapmentsyndrome, celiac arteryDunbarMedian arcuate ligament
The result's identifiers
Result code in IS VaVaI
Alternative codes found
RIV/00064165:_____/18:10367535
Result on the web
DOI - Digital Object Identifier
Alternative languages
Result language
angličtina
Original language name
Intraoperative measurement of pressure gradient in median arcuate ligament syndrome as a rationale for radical surgical approach
Original language description
Background: Median arcuate ligament syndrome (MALS) describes clinical symptoms in patients with stenosis of the celiac artery due to external compression by the ligament. There is an ongoing debate, whether sole release of the median arcuate ligament warrants long-term relief of the symptoms. Materials and methods: Eight patients diagnosed with MALS underwent open surgical treatment beginning with the release of the ligament. Systemic pressure and pressure in the left gastric artery were measured before and after division of the median arcuate ligament and release of the celiac artery. In patients with persistent gradient above 15 mm Hg after the release a PTFE bypass was performed. Results: After the release, the pressure gradient decreased from 66 +- 19 to 48 +- 14 mm Hg (p = .001) and therefore in all patients either an aorto-celiac bypass (n = 6) or aorto-hepatic bypass (n = 2) was created. Consequently, the gradient decreased to 7 +- 2 mm Hg (p = .0001). One month postoperatively, three patients were free of symptoms and the rest reported relief of symptoms. Conclusions: Release of the celiac artery resulted in insufficient decrease of pressure gradient, which was achieved by bypassing the segment with favorable mid-term outcome. We believe that the effect of the release should always be assessed to decide on subsequent treatment.
Czech name
—
Czech description
—
Classification
Type
Jimp - Article in a specialist periodical, which is included in the Web of Science database
CEP classification
—
OECD FORD branch
30201 - Cardiac and Cardiovascular systems
Result continuities
Project
NV15-27941A: The use of nonatigen fish collagen in construction of implants and as drug carriers.
Continuities
I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace
Others
Publication year
2018
Confidentiality
S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů
Data specific for result type
Name of the periodical
Acta Chirurgica Belgica
ISSN
0001-5458
e-ISSN
—
Volume of the periodical
118
Issue of the periodical within the volume
1
Country of publishing house
BE - BELGIUM
Number of pages
6
Pages from-to
36-41
UT code for WoS article
000430091600006
EID of the result in the Scopus database
2-s2.0-85028894721
Basic information
Result type
Jimp - Article in a specialist periodical, which is included in the Web of Science database
OECD FORD
Cardiac and Cardiovascular systems
Year of implementation
2018