Prevalence of median arcuate ligament syndrome and associated visceral artery aneurysms: Insights from computed tomography radiology reports in a single institution and management strategies.

PURPOSE: This study investigated the prevalence of median arcuate ligament syndrome (MALS) and its association with visceral artery aneurysms based on radiological computed tomography (CT) reports from a single institution.

METHODS

Among 392,111 abdominal CT scans (211,685 unique patients), 128 (0.06%) of celiac artery stenosis caused by MAL compression were identified after excluding calcified stenosis.

RESULTS

Of 128 patients, 18 (14.1%) were symptomatic and presented with abdominal pain, discomfort, or bowel irregularities. Two symptomatic patients underwent MAL release surgery, while the other 16 were managed conservatively with medication. Aneurysmal formation secondary to celiac artery stenosis was observed in 54 cases (42.2%), with no reported rupture or dissection. Pancreaticoduodenal artery aneurysms were identified in 6 cases (4.7%), which were treated with endovascular intervention or MAL release. Over a mean follow-up period of 57 months (100 patients), no recurrence or new aneurysm formation was observed. A positive correlation (r = 0.52) was found between the stenosis rate and post-stenotic vessel diameter, highlighting a potential link between stenosis severity and aneurysm formation.

CONCLUSION

The prevalence was low, with most cases being asymptomatic. Further studies are needed to better understand the role of MAL release in managing pancreaticoduodenal aneurysms and preventing aneurysm formation.