ECR 2018 / C-2499
Complications of vascular impingement in the median arcuate ligament syndrome
Congress: ECR 2018
Poster No.: C-2499
Type: Educational Exhibit
Keywords: Obstruction / Occlusion, Hemorrhage, Aneurysms, Embolisation, Complications, Arterial access, Ultrasound-Colour Doppler, Percutaneous, CT-Angiography, Vascular, Arteries / Aorta, Abdomen
Authors: S. Accogli, V. Napoli, M. Gabelloni, R. Cioni, D. Caramella; Pisa/IT
DOI:10.1594/ecr2018/C-2499

Conclusion

 

 The coeliac stenosis by the MAL must be taken seriously since it 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. Transcatheter coil embolization is the treatment of choice in all patients, with CA decompression and recanalization to prevent ischemic complications in cases where major collateral circulation cannot be otherwise preserved (Fig. 16).

 Coeliac compression caused by MAL should be considered in any patient with a true aneurysm PDA vascular territory14.

 When peri-pancreatic hematoma and abdominal pain are observed in the absence of a relevant medical history or abnormal feature on CT imaging, rupture of a PDA aneurysm must be considered15 and percutaneous coil embolization must be performed (Fig. 17).

 

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