Treatment of Celiac Artery Compression Syndrome When Median Arcuate Ligament Release Fails

Surgical release of the median arcuate ligament is the first-line intervention for celiac artery compression syndrome. When that procedure does not achieve the intended goal, a structured next-line protocol addresses the residual vascular problem.

First-Line Failure Condition

First-line goal not achieved

The first-line procedure — median arcuate ligament release (MALR), performed by the laparoscopic (LMALR), open, or robotic (RMALR) approach — targets relief of symptoms with resolution of postprandial abdominal pain. When this goal is not met, escalation to this protocol is indicated.

Next-Line Approach

When residual stenosis of the celiac trunk persists after MAL release, an endovascular intervention targeting the celiac trunk is considered — with patency at 6-month follow-up as the primary success measure. The full selection criteria, procedural details, and follow-up protocol are in the complete regimen.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.3390/jvd4010011

The ACR Appropriateness Criteria guidelines report that after MAL release, stenting is recommended in patients with residual CT stenosis, i.e., >30%, because it reduces the risk of recurrent symptoms by improving hemodynamics.

In addition, 92% of patients were treated with the covered balloon expandable stent achieving a high success rate.

At 6-month follow-up, the percentage of primary patency was 82%, while secondary patency due to reintervention was 100%.

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