Median Arcuate Ligament Compression of the Mesenteric Vasculature

Compression of the celiac artery by fibrous bands of the diaphragmatic crura has been associated with gastrointestinal symptoms such as postprandial pain and delayed gastric emptying, a phenomenon known as median arcuate ligament syndrome. The hemodynamic effects of this compression have also been implicated in the development of aneurysms of the celiac artery or its visceral collaterals. Both open surgical decompression and laparoscopic decompression of the celiac artery have proven effective in the treatment of the compressive syndrome. Endovascular stent placement has largely supplanted open surgical reconstruction for residual stenosis following surgical decompression but is not recommended as the sole treatment modality due to high failure rates. Endovascular techniques have also become the mainstay of management of aneurysmal disease associated with celiac artery compression.