de la Concha TM, Lara RRI, Ramírez GVA, García AIA, Ortiz CJP, Ibarrola CJL

Language: Spanish
References: 13
Page: 25--30
PDF size: 534.67 Kb.

ABSTRACT

Medium arcuate ligament syndrome (SLAM) is a rare entity that occurs due to chronic compression of the artery and coeliac plexus by the middle arcuate ligament (LAM). Clinical presentation is insidious and a high suspicion rate is needed. Diagnosis is challenging since there is no universal criteria and image findings do not predict response to medical treatment. Separation of LAM is the treatment of choice. Endovascular techniques may be used for relapses and associated aneurysms.
We present the clinical case of a 63-year-old female patient admitted with pneumonia and concomitant chronic abdominal pain in which celiac trunk stenosis and retroperitoneal hemorrhage is confirmed by angiotomography. The literature of this controversial syndrome is reviewed.

REFERENCES

1. Terlouw LG, Moelker A, Abrahamsen J, Acosta S, Bakker OJ, Baumgartner I, et al. European guidelines on chronic mesenteric ischaemia – joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia. United Eur Gastroenterol J. 2020;8(4):371-95.

2. Goodall R, Landridge B, Onida S, Ellis M, Huw Davies A. Median arcuate ligament syndrome. J Vasc Surg. 2019;71(6): 2170-6. https://doi.org/10.1016/j.jvs.2019.11.012

3. Dyches R, Eaton K, Smith H. The Roles of Celiac Trunk Angle and Vertebral Origin in Median Arcuate Ligament Syndrome. Diagnostics. 2020;10(2):76.

4. Kim EN, Lamb K, Relles D, Moudgill N, DiMuzio PJ, Eisenberg JA. Median Arcuate Ligament Syndrome - Review of this rare disease. JAMA Surg. 2016;151(5):471-7.

5. Selvaraj BJ, Joshi M, Weber G, Yarmush J. Celiac plexus block as a diagnostic tool in suspected pediatric median arcuate ligament syndrome. Local Reg Anesth. 2019;12:15‐18.

6. Weber J, Boules M, Fong K, Abraham B, Bena J, El-Hayek K, Kroh M and Michael Park W. Median Arcuate Ligament Syndrome Is Not a Vascular Disease. Ann Vasc Surg, 2016;30:22-7.

7. Heo S, Kim HJ, Kim B, Lee JH, Kim J, Kim JK. Clinical impact of collateral circulation in patients with median arcuate ligament syndrome. Diagn Interv Radiol. 2018;24(4):181‐6. https://doi.org/10.5152/dir.2018.17514.

8. Yamana F, Ohata T, Kitahara M, Nakamura M, Yakushiji H, Nakahira S. Blood flow modification might prevent secondary rupture of multiple pancreatoduodenal artery arcade aneurysms associated with celiac axis stenosis. J Vasc Surg Cases Innov Tech. 2020 Mar;6(1):41-5.

9. Khrucharoen U, Juo YY, Sanaiha Y, Finn JP, Jimenez JC, Dutson EP. Factors Associated with Symptomology of Celiac Artery Compression and Outcomes following Median Arcuate Ligament Release. Ann Vasc Surg. 2020;62:248-57.

10. Cienfuegos J, Estevez M, Ruiz-Canela M, Pardo F, Diez-Caballero A, Vivas I et al. Laparoscopic Treatment of Median Arcuate Ligament Syndrome: Analysis of Long-Term Outcomes and Predictive Factors. J Gastrointest Surg. 2017;22(4):713-21.

11. Patel M, Dalag L, Weiner A, Skelly C, Lorenz J. Inability of conventional imaging findings to predict response to laparoscopic release of the median arcuate ligament in patients with celiac artery compression. J Vasc Surg. 2019;69(2):462-9.

12. Bayat I, Wang J, Ho P, Bird D. Intravascular ultrasoundguided laparoscopic division of the median arcuate ligament. J Vasc Surg Cases Innov Tech. 2020;6(1):147‐151.

13. Sahm M, Otto R, Pross M, Scholbach T, Mantke R. Laparoscopic therapy of the coeliac artery compression syndrome: a critical analysis of the current standard procedure. Ann R Coll Surg Engl. 2020;102(2):104-9.