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Median arcuate ligament syndrome

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of median arcuate ligament syndrome are prepared by our editorial team based on guidelines from the Society for Vascular Surgery (SVS 2021,2020) and the European Association for Gastroenterology, Endoscopy and Nutrition (EAGEN/CIRSE/NVMDL/HSGO/UEG/DMIS/ESGAR 2020). ...
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Screening and diagnosis

Differential diagnosis: as per SVS 2021 guidelines, obtain an expedited workup to exclude gastrointestinal malignancies and other potential causes in patients with abdominal pain, weight loss, and fear of food, including investigations such as:
upper and lower gastrointestinal endoscopy
abdominal CT
abdominal ultrasound.
B
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Diagnostic investigations

Diagnostic imaging
As per CIRSE/DMIS/EAGEN/ESGAR/HSGO/NVMDL/UEG 2020 guidelines:
Obtain inspiration/expiration duplex ultrasound, CTA, or contrast-enhanced MRA for the diagnosis of celiac artery compression in MALS.
B
Obtain duplex ultrasound or contrast-enhanced MRA (≤ 2 mm slices with 3D reconstructions) in inspiration and expiration in younger patients with suspected MALS.
B

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  • Screening for mesenteric aneurysms

Therapeutic procedures

Celiac artery stenting: as per CIRSE/DMIS/EAGEN/ESGAR/HSGO/NVMDL/UEG 2020 guidelines, do not perform endovascular stenting of the celiac artery in patients with MALS (and no preceding adequate celiac artery release).
D

Surgical interventions

Celiac artery release: as per CIRSE/DMIS/EAGEN/ESGAR/HSGO/NVMDL/UEG 2020 guidelines, consider performing surgical celiac artery release in patients with MALS.
C