In Reply to: Case 997_05 -- Median arcuate ligament syndrome posted by Editor on September 16, 1997 at 10:57:08:
As emphasized by prior comments, this is a controversial topic. I believe that this entity may cause symptoms, but doubt very much that isolated celiac compression syndrome/median arcuate ligament syndrome can cause ischemic symptoms; I think, more likely, there is a neural basis for the symptomatology. For this reason, and because the abnormality results from extrinsic compression, I very much doubt that angioplasty or stenting will have any salutary effect. With stenting, I believe that the stent will become rather mangled in short order.
I do wonder whether this syndrome might contribute to ischemic symptoms in the proper setting. I have seen a case which fits the criteria for celiac compression syndrome in which (unlike the current case and most cases) significant sma collaterals were present; thus, it seems that celiac compression syndrome may become hemodynamically significant. If so, it might contribute to intestinal angina if the sma and ima were also significantly diseased, say by atherosclerosis. On the other hand, one would guess in such an instance that the patient would probably have developed atherosclerotic changes at the celiac origin in addition to the compressive pathology. Is anyone aware of whether celiac compression syndrome accelerates the development of atherosclerosis at the celiac origin?