• Meagan Kozhimala, Shin Mei Chan, Gabe Weininger, Brandon J Sumpio, Louis J Levine, Sean Harris, Sijin Zheng, Walter E Longo, Ochoa ChaarCassiusCFrom the Division of Vascular and Endovascular Surgery (Kozhimala, Harris, Chaar, Guzman, BE Sumpio), New Haven, CT., Raul J Guzman, and Bauer E Sumpio.
• From the Division of Vascular and Endovascular Surgery (Kozhimala, Harris, Chaar, Guzman, BE Sumpio), New Haven, CT.
• J. Am. Coll. Surg. 2023 Jun 1; 236 (6): 108510911085-1091.

BackgroundMedian arcuate ligament syndrome (MALS) is a frequent differential diagnosis in patients with postprandial abdominal symptoms, but diagnosis remains challenging. The aim of this study was to identify characteristics of patients who had MALS compared with non-MALS patients among a cohort of patients diagnosed with celiac artery compression (CAC).Study DesignAn IRB-approved retrospective chart review (2000 to 2021) of patients at our institution with a discharge diagnosis of CAC was performed. Medical record review for clinical symptoms and findings consistent with MALS was performed.ResultsTwo hundred ninety-three patients with a diagnosis of CAC were identified; 59.7% were women, and average age was 63.9 ± 20.2 years. Sixty-nine (23.5%) patients with CAC had MALS. There were no significant differences in sex or race between MALS and non-MALS patients, but MALS patients were younger (55.7 vs 68.1, p < 0.001). There was no significant difference in gastrointestinal comorbidities between the 2 groups. Patients with MALS were less likely to have diabetes (12.5% vs 26.9%), renal disease (4.6% vs 8.2%), hypertension (41.5% vs 70.3%), mesenteric atherosclerotic disease (14% vs 61.9%), and peripheral artery disease (15.0% vs 39.7%).ConclusionsWe demonstrate a novel observation that MALS patients tend to have fewer atherosclerotic characteristics than non-MALS patients with CAC. Patients in our study with MALS were more likely to be younger, women, and presenting with epigastric pain. MALS patients had a significantly lower incidence of diabetes, hypertension, renal disease, mesenteric artery disease, and peripheral arterial disease compared with the non-MALS group. An important clinically relevant feature of MALS patients may be their lack of atherosclerotic phenotype compared with non- MALS patients with CAC.Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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