Clinical Outcomes after Median Arcuate Ligament Release in Patients Responsive to Celiac Plexus Block

J Vasc Interv Radiol. 2024 Apr;35(4):558-562. doi: 10.1016/j.jvir.2023.12.569. Epub 2024 Jan 3.

Abstract

Purpose: To determine if symptom relief with celiac plexus block (CPB) is associated with favorable clinical outcomes after median arcuate ligament release (MALR) surgery.

Materials and methods: A retrospective review was performed from January 2000 to December 2021. Fifty-seven patients (42 women, 15 men; mean age, 43 years [range, 18-84 years]) with clinical and radiographic features suggestive of median arcuate ligament syndrome (MALS) underwent computed tomography (CT)-guided percutaneous CPB for suspected MALS. Clinical outcomes of CPB and MALR surgery were correlated. Adverse events were classified according to the Society of Interventional Radiology (SIR) guidelines.

Results: CT-guided percutaneous CPB was successfully performed in all 57 (100%) patients with suspected MALS. A cohort of 38 (67%) patients showed clinical improvement with CPB. A subset of 28 (74%) patients in this group subsequently underwent open MALR surgery; 27 (96%) responders to CPB showed favorable clinical outcomes with surgery. There was 1 (4%) CPB-related mild adverse event. There were no moderate, severe, or life-threatening adverse events.

Conclusions: Patients who responded to CPB were selected to undergo surgery, and 96% of them improved after surgery.

MeSH terms

  • Adult
  • Celiac Artery / diagnostic imaging
  • Celiac Artery / surgery
  • Celiac Plexus* / diagnostic imaging
  • Celiac Plexus* / surgery
  • Decompression, Surgical / adverse effects
  • Female
  • Humans
  • Ligaments / diagnostic imaging
  • Ligaments / surgery
  • Male
  • Median Arcuate Ligament Syndrome* / complications
  • Median Arcuate Ligament Syndrome* / diagnostic imaging
  • Median Arcuate Ligament Syndrome* / surgery