Median arcuate ligament syndrome (also known as celiac artery compression syndrome) refers to the compression of the celiac axis by an abnormally low median arcuate ligament. The median arcuate ligament is a fibrous band that connects the diaphragmatic crura at the aortic hiatus. In 10%–25% of people, it crosses in front of the celiac trunk and may cause symptoms. The arterial compression usually varies with respiration and worsens with expiration.
Median arcuate ligament syndrome does not respond to angioplasty, and stents are not used due to possible device fatigue. Surgery to enlarge the diaphragmatic hiatus or resect the celiac ganglion is the preferred.
On angiography, there is a characteristic focal narrowing in the proximal celiac axis with a hooked appearance. Injection of the superior mesenteric artery can lead to retrograde opacification of the celiac artery via the gastroduodenal and pancreaticoduodenal arteries if the compression is severe enough.
References
Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 2005 Sep-Oct;25(5):1177-82.
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