To describe imaging findings of impingement of coeliac artery (CA) by median arcuate ligament (MAL) and its complications,
such as pancreaticoduodenal (PD) arcade aneurysm formation and rupture with bleeding. To illustrate most the currenttherapeutic criteria and the wide range of treatment options,
aimed at both the treatment and prevention of vascular complications of MAL syndrome (MALS).
MAL is a fibrous arch bridging the diaphragmatic crura on either side of the aortic hiatus,
normally passing over the aorta at the level of L1,
superior to the coeliac artery origin.
In 10-24% of cases,
it is low-lying and might cross over the proximal portion of CA,
causing extrinsic compression of the vessel 1 ( Fig. 1 ) . Most patients are asymptomatic.
However,some of them may develop symptoms of MALS or Dunbar syndrome,
such as post-prandial abdominal pain,
Findings and procedure details
Digital subtraction angiography (DSA) is the reference imaging technique to diagnose CA stenosis due to compression by the MAL,
revealing a characteristic superior indentation along the proximal CA about 5 mm from its origin 11 ( Fig. 4 ).
During inspiration the compression is often lifted up and the indentation results less evident since abdominal viscera descend and CA has a more caudal orientation; conversely,
impingement in MALS is more marked during expiration,
even up to vessel...
The coeliac stenosis by the MAL must be taken seriously sinceit might increase retrograde collateral blood flow from the SMA to the CA perfusion area via PD arcade,
develop hypertrophic collaterals and form PDA aneurysms. A close follow-up of patients diagnosed with MALS who develop collaterals is recommended.
If PDA aneurysms are diagnosed,
treatment should be considered when the aneurysm-to-artery size ratio approaches three.
Transcathetercoil embolizationis thetreatment of choicein all...
Dr.Sandra Accogli Resident in training.
Diagnostic and Interventional Radiology. University of Pisa. Email: firstname.lastname@example.org Prof.
Davide Caramella Professor and Chairman.
Diagnostic and Interventional Radiology. University of Pisa. Email:email@example.com Dr.
Roberto Cioni Director Interventional Radiology Unit.
University Hospital Pisa. Email: firstname.lastname@example.org Dr.
Vinicio Napoli University Radiology Unit 1.
University Hospital Pisa. Email:...
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DOI: 10.1007/s00270-016-1560-6 . Karahan OI,
Ok E. Celiac artery compression syndrome: diagnosis with multislice CT....