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Ohyama S, Kotani T, Takeuchi T, Sunami T, Iijima Y, Okuwaki S, Aoki Y, Sakashita K, Iwata S, Sakuma T, Akazawa T, Inage K, Shiga Y, Minami S, Ohtori S. Analysis of the relationship between spinal alignment and retrocrural space area in adult spinal deformity surgery: Potential risk factors for acute celiac artery compression syndrome. J Orthop Sci 2024; 29:514-520. [PMID: 36931979 DOI: 10.1016/j.jos.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/05/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE This study was designed to reveal the association between spinal parameters and RCS area in patients with adult spinal deformities treated with spinal correction surgery. We hypothesized that reduction of the retrocrural space (RCS) area is related to thoracolumbar alignment, which may cause acute celiac artery compression syndrome (ACACS). METHODS Eighty-nine patients (age: 68.4 ± 7.6 years; sex: 7 male/82 female) with ASD treated by spinal correction surgery were enrolled. Preoperative and postoperative spinal parameters were measured, and the differences between these parameters were calculated. Postoperative T12 translation was measured and RCS area was evaluated using reconstructed computed tomography. The change of RCS area after surgery was defined as ΔRCS. Patients were divided into increased and decreased RCS groups by the ΔRCS value, and spinal parameters were compared between groups. The correlation between spinal parameters and ΔRCS was calculated. RESULTS The patients in the decreased RCS group had greater anterior T12 translation than those in the increased RCS group (p < 0.001). T12 translation was significantly correlated with ΔRCS (β = -0.31, p = 0.017). There were no correlations between ΔRCS and other spinal parameters. CONCLUSION Thoracolumbar alignment was associated with RCS area. Consistent with the hypothesis, overcorrection of the thoracolumbar junction was associated with reduced RCS area and might be one risk factor for ACACS.
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Affiliation(s)
- Shuhei Ohyama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan.
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Takashi Takeuchi
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takahiro Sunami
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Shun Okuwaki
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Yasuchika Aoki
- Department of Orthopedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Kotaro Sakashita
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shuhei Iwata
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsutomu Akazawa
- Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Metz FM, Blauw JTM, Brusse-Keizer M, Kolkman JJ, Bruno MJ, Geelkerken RH. Systematic Review of the Efficacy of Treatment for Median Arcuate Ligament Syndrome. Eur J Vasc Endovasc Surg 2022; 64:720-732. [PMID: 36075541 DOI: 10.1016/j.ejvs.2022.08.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Since the first description of the median arcuate ligament syndrome (MALS), the existence for the syndrome and the efficacy of treatment for it have been questioned. METHODS A systematic review conforming to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was conducted, with a broader view on treatment for MALS including any kind of coeliac artery release, coeliac plexus resection, and coeliac plexus blockage, irrespective of age. Online databases were used to identify papers published between 1963 and July 2021. The inclusion criteria were abdominal symptoms, proof of MALS on imaging, and articles reporting at least three patients. Primary outcomes were symptom relief and quality of life (QoL). RESULTS Thirty-eight studies describing 880 adult patients and six studies describing 195 paediatric patients were included. The majority of the adult studies reported symptom relief of more than 70% from three to 228 months after treatment. Two adult studies showed an improved QoL after treatment. Half of the paediatric studies reported symptom relief of more than 70% from six to 62 months after laparoscopic coeliac artery release, and four studies reported an improved QoL. Thirty-five (92%) adult studies and five (83%) paediatric studies scored a high or unclear risk of bias for the majority of the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) items. The meaning of coeliac plexus resection or blockage could not be substantiated. CONCLUSION This systematic review suggests a sustainable symptom relief of more than 70% after treatment for MALS in the majority of adult and paediatric studies; however, owing to the heterogeneity of the inclusion criteria and outcome parameters, the risk of bias was high and a formal meta-analysis could not be performed. To improve care for patients with MALS the next steps would be to deal with reporting standards, outcome definitions, and consensus descriptions of the intervention(s), after which an appropriate randomised controlled trial should be performed.
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Affiliation(s)
- Flores M Metz
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands; Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, the Netherlands.
| | - Juliëtte T M Blauw
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands; Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, the Netherlands
| | - Marjolein Brusse-Keizer
- Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, the Netherlands; Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Health Technology and Services Research, University of Twente, Enschede, the Netherlands
| | - Jeroen J Kolkman
- Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, the Netherlands; Department of Gastroenterology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands; Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, the Netherlands
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Sun Z, Fritz DA, Turner S, Hardy DM, Meiler SE, Martin DC, Dua A. Celiac Plexus Block as a Predictor of Surgical Outcome for Sympathetically Mediated Abdominal Pain in a Case of Suspected Median Arcuate Ligament Syndrome. A A Pract 2018; 11:76-78. [DOI: 10.1213/xaa.0000000000000743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Matsumoto AH, Muehle C, Casada D, Navid F, Tegtmeyer CJ, Tribble CG. Compression of the Superior Mesenteric Artery by the Median Arcuate Ligament: A Cause for Mesenteric Ischemia. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857449402800707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Extrinsic compression of the superior mesenteric artery (SMA) by the median arcuate ligament (MAL) is an uncommon entity. The authors report a case of compression of the SMA by the MAL in a patient with celiac artery occlusion and intestinal angina. Arteriography and computerized tomography were suggestive of the diagnosis. Division of the fibrous bands of the MAL extending onto the anterior surface of the SMA relieved the arterial compression, with subsequent resolution of the patient's symptoms.
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Affiliation(s)
- Alan H. Matsumoto
- Department of Radiology, Division of Angiography and Interventional Radiology, University of Virginia Health Sciences Center
| | - Casey Muehle
- Department of Radiology, Division of Angiography and Interventional Radiology, University of Virginia Health Sciences Center
| | - David Casada
- Department of Radiology, Division of Angiography and Interventional Radiology, University of Virginia Health Sciences Center
| | - Forozan Navid
- Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia
| | - Charles J. Tegtmeyer
- Department of Radiology, Division of Angiography and Interventional Radiology, University of Virginia Health Sciences Center
| | - Curtis G. Tribble
- Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia
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Tribble CG, Harman PK, Mentzer RM. Celiac Artery Compression Syndrome: Report of a Case and Review of Current Opinion. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857448602000211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The celiac artery compression syndrome (or median arcuate ligament syn drome) is characterized by postprandial abdominal pain, an epigastric bruit, and arteriographic evidence of significant extrinsic compression of the celiac artery. Although the concept of extrinsic compression of vessels is well estab lished in vascular surgery, the existence of the celiac artery compression syn drome has been a matter of controversy. A patient relieved of celiac artery compression and postprandial pain is presented. A review of the controversy and an approach to evaluating patients suspected of having this type of com pression is outlined.
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Affiliation(s)
- Curtis G. Tribble
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - P. Kent Harman
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Robert M. Mentzer
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
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Open and laparoscopic treatment of median arcuate ligament syndrome. J Vasc Surg 2012; 56:869-73. [PMID: 22743019 DOI: 10.1016/j.jvs.2012.04.057] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/26/2012] [Accepted: 04/27/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Median arcuate ligament syndrome (MALS) is a syndrome associated with chronic abdominal pain and radiographic evidence of celiac artery compression. We compared the evidence for both open and laparoscopic treatment of patients with MALS. METHODS We reviewed the English-language literature between 1963 and 2012. Presenting symptoms, clinical improvement, operative details, and intraoperative and postoperative complications were noted. RESULTS A total of 400 patients underwent surgical (open and laparoscopic) treatment for MALS. Three hundred thirty-nine patients reported immediate postoperative symptom relief (85%). Late recurrence of symptoms was reported in 19 patients in the open group (6.8%) and seven patients in the laparoscopic group (5.7%). Eleven out of 121 patients (9.1%) in the laparoscopic group required open conversion secondary to bleeding. CONCLUSIONS The available evidence demonstrates that both laparoscopic and open ligament release, celiac ganglionectomy, and celiac artery revascularization may provide sustained symptom relief in the majority of patients diagnosed with MALS. The role of arterial revascularization following ligament release remains unclear. The rate of open conversion with the laparoscopic approach is high, but no perioperative deaths have been reported.
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Tulloch AW, Jimenez JC, Lawrence PF, Dutson EP, Moore WS, Rigberg DA, Derubertis BG, Quinones-Baldrich WJ. Laparoscopic versus open celiac ganglionectomy in patients with median arcuate ligament syndrome. J Vasc Surg 2010; 52:1283-9. [PMID: 20630683 DOI: 10.1016/j.jvs.2010.05.083] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 05/12/2010] [Accepted: 05/12/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Median arcuate ligament syndrome (MALS) is a rare disorder characterized by abdominal pain and compression of the celiac artery. Traditional management consists of open MAL division, with or without arterial reconstruction. We present our outcomes using a laparoscopic approach and compare them to patients treated with open MAL division during the same period. METHODS A retrospective medical records review of all patients with MALS treated at the University of California-Los Angeles from January 1999 to 2009 was performed. RESULTS Fourteen patients with MALS were treated. All patients underwent an extensive preoperative gastrointestinal (GI) workup with 10 undergoing attempted laparoscopic division of the MAL and celiac ganglion (laparoscopic ganglionectomy [LG]). Two intraoperative conversions were performed for bleeding. Six patients were treated in the open surgery group (open ganglionectomy [OG]). There were no deaths or reoperations in either group. Median time to feeding was 1.0 vs 2.8 days (P≤.05) in the LG and OG groups, respectively, which was statistically significant. Median length of hospitalization was also significantly lower in the LG group compared with the OG group (2.3 vs 7.0 days; P≤.05). Eight patients had LG (100%) and 5 patients had OG (83%) and had immediate symptom resolution (postoperative day 1). Three patients with recurrent symptoms after LG underwent angiography demonstrating persistent celiac stenosis, then an angioplasty was performed. Median follow-up was 14.0 months (2-65 months) for all patients. Three patients who received LG (38%) and 3 patients who received OG (50%) had persistent pain at last follow-up. Six patients in the OG group (100%) and 7 patients in the LG group (88%) had ceased taking chronic oral narcotics at their last follow-up visit. CONCLUSION Both laparoscopic and open MAL division and celiac ganglionectomy can be safely performed with minimal patient morbidity and mortality. Late recurrence is frequently seen; however, this seems to be milder than the presenting symptoms. The laparoscopic approach results in avoidance of laparotomy and was associated with shorter inpatient hospitalization and decreased time to feeding in our study. Optimal patient selection and prediction of clinical response in these patients remains a challenge.
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Affiliation(s)
- Allan W Tulloch
- Division of Vascular Surgery, University of California-Los Angeles School of Medicine, Los Angeles, CA 90095, USA
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Roseborough GS. Laparoscopic management of celiac artery compression syndrome. J Vasc Surg 2009; 50:124-33. [PMID: 19563960 DOI: 10.1016/j.jvs.2008.12.078] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 12/04/2008] [Accepted: 12/21/2008] [Indexed: 10/20/2022]
Abstract
BACKGROUND Celiac artery compression syndrome (CACS) remains a controversial diagnosis, despite several reported series documenting therapeutic efficacy of CA decompression. Traditional therapy consists of open surgical decompression, but since 2000, five isolated case reports have been published in which CACS has been successfully treated with laparoscopic techniques. This approach was adopted as the sole initial therapy for CACS at the Johns Hopkins Hospital in 2002. This article reports the results of a unique surgical series that triples the reported worldwide experience with this therapy. METHODS Fifteen patients (median age, 40.6 years) diagnosed with CACS underwent laparoscopic decompression by a single vascular surgeon. CACS was diagnosed by digital subtraction angiography in 14 patients and computed tomography (CT) angiography in one patient, with images acquired in both expiratory and inspiratory phases of respiration. CA decompression was offered after the results of a thorough workup for other pathology were negative, including upper and lower endoscopy, CT scanning, gastric and gallbladder emptying studies, upper gastrointestinal series, and small-bowel follow-through studies. Indications in all patients were abdominal pain and weight loss (average, 9 lbs). The procedure consisted of laparoscopic division of the median arcuate ligament and complete lysis of the CA from its origin on the aorta to its trifurcation. RESULTS Between November 2002 and September 2007, 15 consecutive patients underwent laparoscopic CA decompression. Median length of follow-up was 44.2 months. There were no operative deaths. Four patients were converted intraoperatively to an open decompression, all for intraoperative bleeding; only one required a blood transfusion. Average operating time was 189 minutes, and the average length of stay was 3.5 days. CA intervention was required in six patients, including three intraoperative procedures (1 patch angioplasty, 1 celiac bypass, 1 percutaneous angioplasty) and six late procedures (2 percutaneous angioplasties, 3 percutaneous stents, 1 celiac bypass). One complication occurred, a severe case of pancreatitis that developed 1 week after discharge. On follow-up, 14 of 15 patients subjectively reported significant improvement, and one patient remains symptomatic with no diagnosis. CONCLUSION Laparoscopic decompression of the CA may be a useful therapy for CACS, but there is potential for vascular injury, and adjunctive CA intervention is often required. Surgeons should consider laparoscopic CA decompression as a therapeutic alternative for CACS and should participate in the care of patients with this diagnosis.
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Affiliation(s)
- Glen S Roseborough
- Division of Vascular Surgery, Johns Hopkins University, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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von Glinski KS, Krettek C, Blauth M, Oldhafer KJ. Hepatic ischemia as a complication after correction of post-traumatic gibbus at the thoracolumbar junction. Spine (Phila Pa 1976) 2000; 25:1040-4. [PMID: 10767819 DOI: 10.1097/00007632-200004150-00021] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a case report of hepatic ischemia secondary to celiac trunk stenosis as a complication after correction of a preoperative 30 degrees gibbus at the thoracolumbar junction. OBJECTIVES A high index of suspicion is needed to make a timely diagnosis of hepatic ischemia in any setting. After spinal reconstruction involving lengthening, symptoms suggestive of an acute abdomen accompanied by markedly elevated liver enzymes should be evaluated with an angiogram to check for celiac trunk stenosis. SUMMARY OF BACKGROUND DATA Review of the literature showed no reported cases of hepatic ischemia or descriptions of the status of celiac trunk stenosis after spinal surgery. Even in more commonly associated settings, diagnosis of both phenomena is often delayed, with possible morbid consequences. METHODS A case is presented of a patient who underwent gibbus correction and re-establishment of lost anterior intervertebral distance at the thoracolumbar junction. After surgery, ischemic hepatitis, a perforated gallbladder, and splenic infarction developed secondary to celiac trunk stenosis-a result of cephalad displacement of the celiac trunk and compression of the artery by the diaphragmatic ligament. RESULTS An emergent exploratory laparotomy with cholecystectomy was performed followed by an angiogram, which demonstrated stenosis of the celiac trunk. After release of the arcuate ligament, the patient's condition improved rapidly, and he made a complete recovery. CONCLUSIONS The consequences of a delay in diagnosis of hepatic ischemia can be disastrous. An awareness of the possibility of this complication after spinal lengthening should facilitate a timely angiogram and operative intervention.
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Affiliation(s)
- K S von Glinski
- San Francisco Residency Program, San Francisco, California, USA
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Abstract
The embryogenesis, congenital anomalies, and surgical anatomy and applications of the esophagus for benign and malignant processes are detailed in this article. Emphasis is placed on the role of embryology and the anatomy involved in surgical decisions.
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Affiliation(s)
- J E Skandalakis
- Center for Surgical Anatomy, Emory University School of Medicine, Atlanta, Georgia, USA
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Abstract
Compression of the visceral arteries can produce true mesenteric ischemia, but the syndrome is rare. The syndrome is caused by unfavorable anatomic relationships at the aortic hiatus among the CA, the SMA, and overlying structures, particularly the diaphragmatic crura. These anatomic relationships, in contrast to the syndrome they sometimes produce, are relatively common, which makes the detection of CA compression only a prerequisite to the diagnosis of the clinical entity. The diagnosis of CA compression syndrome ultimately depends on the relentless elimination of other possible causes for abdominal pain and on the knowledge that this curious syndrome does indeed exist. If properly diagnosed, the CA compression syndrome can be corrected with a safe, relatively simple surgical procedure. Past treatment series reflect too little appreciation for the extensiveness of a true, chronic CA injury. Revascularization of the CA, in addition to release of compression, should therefore be performed with greater frequency in the future. The young patients who are successfully diagnosed and treated for this unusual syndrome are frequently entirely relieved of long-standing, debilitating pain, and, like other patients with chronic mesenteric ischemia, they typically enjoy dramatic improvement in the quality of their lives. Thus, with the prospect of these patients in mind, a clinician should accept the opinion that the syndrome "does not exist" only after careful consideration of the entire literature.
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Affiliation(s)
- F R Bech
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Would you recognize celiac axis syndrome? Postgrad Med 1991; 89:239-40, 245, 248. [PMID: 1985315 DOI: 10.1080/00325481.1991.11700801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Since its original description, celiac axis syndrome has been a topic of debate. Clinical findings include postprandial abdominal pain, weight loss, and an epigastric bruit. Diagnosis is often made by exclusion and is confirmed by lateral aortography. The role of surgery in treating celiac axis syndrome is controversial.
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Rogers DM, Thompson JE, Garrett WV, Talkington CM, Patman RD. Mesenteric vascular problems. A 26-year experience. Ann Surg 1982; 195:554-65. [PMID: 7073353 PMCID: PMC1352557 DOI: 10.1097/00000658-198205000-00004] [Citation(s) in RCA: 118] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Mesenteric vascular problems are infrequent, but may be catastrophic. During a 26-year period, 55 private patients were treated for the following disorders: (1) 12 patients with visceral artery aneurysms, (2) 8 with celiac compression syndrome, (3) 13 with chronic mesenteric ischemia, (4) 12 with acute mesenteric ischemia, and (5) 10 with mesenteric ischemia associated with aortic reconstructions. Splenic artery aneurysms were managed by excision and splenectomy, while celiac and hepatic had excision with graft replacement. Patients with celiac compression syndrome underwent lysis of the celiac artery. Two patients had compression of both celiac and superior mesenteric artery (SMA). One patient required vascular reconstruction of both arteries for residual stenoses. Patients having chronic mesenteric ischemia were treated with bypass grafts, with one death (7.7% mortality) and good long-term results. Those with acute mesenteric ischemia were treated by SMA embolectomy, bowel resection, or both, with a mortality of 67%. When associated with aortic reconstructions, mesenteric ischemia carried a mortality of 100% if bowel infarction occurred after operation, but when prophylactic mesenteric revascularization was performed at the time of aortic surgery, prognosis was greatly improved, with only one death among six patients. An aggressive approach including prompt arteriography with early diagnosis and surgical therapy is advocated for these catastrophic acute mesenteric problems.
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Grundmann R, Schoenemann B, Horsch S, Kallenberg A. [Surgical consequences of anomalous arterial blood supply and aneurysms in the epigastric region (authors' translation)]. LANGENBECKS ARCHIV FUR CHIRURGIE 1980; 353:35-46. [PMID: 7206978 DOI: 10.1007/bf01261796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Abdominal angiography was performed in patients with occlusive disease of the iliofemoral arteries. In 85 of 389 patients, the anomalous arterial blood supply of the upper abdomen was detected accidentally: 81% of the variations were related to the hepatic artery, 19% to the celiac artery. The possible surgical consequences are discussed if these variations are disregarded. Four patients with aneurysms of the visceral arteries (three aneurysms of the hepatic artery, one aneurysm of the superior mesenteric artery) and one patient with a celiac artery compression syndrome were also detected. The latter diseases represent clear indication for operation with high chances of success if treated in time.
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Brandt LJ, Boley SJ. Celiac axis compression syndrome. A critical review. THE AMERICAN JOURNAL OF DIGESTIVE DISEASES 1978; 23:633-40. [PMID: 685929 DOI: 10.1007/bf01072599] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
Six patients with symptomatic celiac axis compression syndrome are reported on. Four were treated surgically with arterial reconstruction. None of these four patients was benefited more than temporarily by the corrective surgery. One patient had an abdominal exploration and highly selective vagotomy unrelated to the celiac axis and is symptom-free ten months after surgery. One patient had no surgery and remains symptomatic. Angiographic evaluation in all patients demonstrated that despite high grade stenosis of the celiac axis, there was no radiographically discernible reduction in constrast flow to the celiac axis because of well developed collaterals from the superior mesenteric artery. These results indicate that compression of the celiac axis may be merely an incidental angiographic finding, so this syndrome needs cautious evaluation.
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Robicsek F, Daugherty HK, Cook JW, Owen BJ. A new method to revascularize the celiac axis. VASCULAR SURGERY 1977; 11:34-9. [PMID: 150712 DOI: 10.1177/153857447701100107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Martinez NS, Khan AH. The relentless symptom complex of undiagnosed celiac artery compression. Angiology 1972; 23:198-204. [PMID: 5030554 DOI: 10.1177/000331977202300403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Curl JH, Thopson NW, Stanley JC. Median arcuate ligament compression of the celiac and superior mesenteric arteries. Ann Surg 1971; 173:314-20. [PMID: 5100103 PMCID: PMC1397631 DOI: 10.1097/00000658-197102000-00022] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Edwards AJ, Hamilton JD, Nichol WD, Taylor GW, Dawson AM. Experience with coeliac axis compression syndrome. BRITISH MEDICAL JOURNAL 1970; 1:342-5. [PMID: 5416813 PMCID: PMC1699005 DOI: 10.1136/bmj.1.5692.342] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Seven patients with "coeliac axis compression syndrome" are reported. Five were treated surgically, but only two did well. A survey of 200 healthy adults showed epigastric bruits in 6.5%; only one of these had dyspepsia, though dyspepsia was present in 12.5% overall.Caution is urged in attributing a causal relationship between coeliac axis compression and pain and in proceeding to arteriography when compression is suspected on clinical grounds.
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Welch CE. Progress in abdominal surgery. Am J Surg 1969; 118:384-90. [PMID: 4309446 DOI: 10.1016/0002-9610(69)90143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Albertazzi VJ, Elliot TE, Kennedy JA. Popliteal artery entrapment. Report of case and review of the literature. Angiology 1969; 20:119-28. [PMID: 5773963 DOI: 10.1177/000331976902000302] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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