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Vol.
XIV
No.
3
JOURNAL OF VASCULAR NURSING
PAGE 81
Celiac Band Syndrome (Median Arcuate Ligament Syndrome) A 36-year-old white female schoolteacher was seen with a 20-year history of epigastric discomfort, cramping, nausea, and diarrhea, but with no appreciable weight loss. She had no findings on abdominal examination other than an epigastric bruit. Extensive gastrointestinal workup, including upper and lower barium studies and abdominal, computed tomographic scan, was unremarkable. An abdominal aortogram (lateral view) showed compression of the celiac axis (Figure 1) with a normal superior mesenteric artery. She was referred for vascular consultation. Compression of the celiac artery by the median arcuate ligament of the diaphragm as the artery originates from the abdominal aorta can often be demonstrated during deep expiration by the use of duplex scanning or arteriography, even in persons without symptoms. 1 The triad of chronic abdominal pain, an epigastric bruit, and compression of the celiac artery comprises the syndrome. Other symptoms described include nausea, abdominal cramping, vomiting, diarrhea, and weight loss. The degree of stenosis has no correlation with therapeutic results. The diagnosis traditionally has been made by means of lateral aortogram, although duplex scanning has recently been shown to be accurate in the identification of visceral artery stenosis, e The results of treatment are variable and in the past have been reported to be poor on long-term follow-up. Many of the patients were noted to develop gastrointestinal/biliary/pancreatic disorders later. A complete gastrointestinal/biliary/pancreatic workup is therefore essential before surgical intervention. Surgery, w h e n indicated, consists of release of the diaphragmatic fibers with or without dilatation or revascularization of the celiac axis. Negative predictors of success include atypical pain, psychiatric or alcohol history, age over 60 years, and weight loss of less than 20 pounds. 3 REFERENCES
1. Harjola PT, Lahtiharju A. Celiac artery syndrome: abdominal angina caused by external compression of the celiac artery. Am J Surg 1968;115:864-9 2. Moneta GL, Yeager RA, Salman R, et al. Duplex ultrasound criteria for diagnosis of splanchnic artery stenosis or occlusion. J Vasc Surg 1991;14:511-20.
Figure 1. Lateral abdominal aortogram shows compression of the celiac axis (arrow) at its origin from the abdominal aorta.
3. Reilly LM, Ammar AD, Stoney RJ. Late results following operative repair for celiac artery compression syndrome. J Vasc Surg 1985;2:79-91. Submitted by
Bhagwan Satiani, MD Peripheral Vascular Surgery, Inc. Columbus, Ohio
XIV
No.
3
JOURNAL OF VASCULAR NURSING
PAGE 81
Celiac Band Syndrome (Median Arcuate Ligament Syndrome) A 36-year-old white female schoolteacher was seen with a 20-year history of epigastric discomfort, cramping, nausea, and diarrhea, but with no appreciable weight loss. She had no findings on abdominal examination other than an epigastric bruit. Extensive gastrointestinal workup, including upper and lower barium studies and abdominal, computed tomographic scan, was unremarkable. An abdominal aortogram (lateral view) showed compression of the celiac axis (Figure 1) with a normal superior mesenteric artery. She was referred for vascular consultation. Compression of the celiac artery by the median arcuate ligament of the diaphragm as the artery originates from the abdominal aorta can often be demonstrated during deep expiration by the use of duplex scanning or arteriography, even in persons without symptoms. 1 The triad of chronic abdominal pain, an epigastric bruit, and compression of the celiac artery comprises the syndrome. Other symptoms described include nausea, abdominal cramping, vomiting, diarrhea, and weight loss. The degree of stenosis has no correlation with therapeutic results. The diagnosis traditionally has been made by means of lateral aortogram, although duplex scanning has recently been shown to be accurate in the identification of visceral artery stenosis, e The results of treatment are variable and in the past have been reported to be poor on long-term follow-up. Many of the patients were noted to develop gastrointestinal/biliary/pancreatic disorders later. A complete gastrointestinal/biliary/pancreatic workup is therefore essential before surgical intervention. Surgery, w h e n indicated, consists of release of the diaphragmatic fibers with or without dilatation or revascularization of the celiac axis. Negative predictors of success include atypical pain, psychiatric or alcohol history, age over 60 years, and weight loss of less than 20 pounds. 3 REFERENCES
1. Harjola PT, Lahtiharju A. Celiac artery syndrome: abdominal angina caused by external compression of the celiac artery. Am J Surg 1968;115:864-9 2. Moneta GL, Yeager RA, Salman R, et al. Duplex ultrasound criteria for diagnosis of splanchnic artery stenosis or occlusion. J Vasc Surg 1991;14:511-20.
Figure 1. Lateral abdominal aortogram shows compression of the celiac axis (arrow) at its origin from the abdominal aorta.
3. Reilly LM, Ammar AD, Stoney RJ. Late results following operative repair for celiac artery compression syndrome. J Vasc Surg 1985;2:79-91. Submitted by
Bhagwan Satiani, MD Peripheral Vascular Surgery, Inc. Columbus, Ohio