Outcome predictors in median arcuate ligament syndrome

Ho, Kelvin Kam Fai, Walker, Philip, Smithers, B. Mark, Foster, Wallace, Nathanson, Leslie, O'Rourke, Nicholas, Shaw, Ian and McGahan, Timothy (2017) Outcome predictors in median arcuate ligament syndrome. Journal of Vascular Surgery, 65 6: 1745-1752. doi:10.1016/j.jvs.2016.11.040

Author Ho, Kelvin Kam Fai
Walker, Philip
Smithers, B. Mark
Foster, Wallace
Nathanson, Leslie
O'Rourke, Nicholas
Shaw, Ian
McGahan, Timothy
Title Outcome predictors in median arcuate ligament syndrome
Journal name Journal of Vascular Surgery   Check publisher's open access policy
ISSN 1097-6809
Publication date 2017-02-08
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.jvs.2016.11.040
Open Access Status Not yet assessed
Volume 65
Issue 6
Start page 1745
End page 1752
Total pages 8
Place of publication Philadelphia, PA, United States
Publisher Mosby
Collection year 2018
Language eng
Formatted abstract
Background: Median arcuate ligament syndrome (MALS) is a condition characterized by chronic abdominal symptoms associated with median arcuate ligament compression of the celiac artery. The selection of patients is difficult in the management of MALS. This study aimed to identify factors that predict outcomes of surgical and nonoperative treatment in these patients.

Methods: Patients referred with a possible diagnosis of MALS between 1998 and 2013 were identified retrospectively. Only patients with chronic symptoms and radiologically confirmed celiac artery compression were included. The clinical features, investigations, and management were documented. Outcome was assessed using the Visick score, Gastrointestinal Symptom Rating Scale, and 12-Item Short Form Health Survey by telephone interview and review of medical records.

Results: There were 67 patients, 43 (64%) treated surgically and 24 (36%) managed without surgery, with a median follow-up of 25 months and 24 months, respectively. After surgical treatment, 16 (37%) were asymptomatic, 24 (56%) were partially improved, 3 (7%) had no changes in symptoms, and none had worsening of symptoms. Postexertional pain predicted improvement after surgery (P = .022). Vomiting (P = .046) and unprovoked pain (P = .006) were predictors of poor surgical outcome. After nonoperative management, 1 (4%) was asymptomatic, 7 (29%) were partially improved, 12 (50%) had no changes in symptoms, and 4 (17%) had worsening of symptoms. No outcome predictors of nonoperative treatment were identified.

Conclusions: MALS was more likely to respond to decompression if patients had postexertional pain. Patients who presented with vomiting and unprovoked pain were unlikely to respond to surgery. In contrast with previous studies, postprandial pain was not found to be predictive of outcome.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
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