Median arcuate ligament syndrome with early collateralization in a liver transplant

The relevance of this fibrous band has been under debate since 1965 when Dunbar et al. first de- scribed a syndrome of postprandial abdominal pain and malabsorption secondary to celiac axis compres- sion by the median arcuate ligament.1 The relevance of this ligament in liver transplantation is wide...

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Bibliographic Details
Published in:The American surgeon 2010-09, Vol.76 (9), p.E156-157
Main Authors: Woodworth, Amanda, Khanmoradi, Kamran, Zaki, Radi, Campos, Stalin, Horrow, Mindy, Ortiz, Jorge
Format: Article
Language:English
Subjects:
Abdomen
Aged
Arterial Occlusive Diseases - diagnostic imaging
Arterial Occlusive Diseases - etiology
Arterial Occlusive Diseases - pathology
Arterial Occlusive Diseases - surgery
Celiac Artery - diagnostic imaging
Celiac Artery - pathology
Celiac Artery - surgery
Collateral Circulation - physiology
Follow-Up Studies
Humans
Imaging, Three-Dimensional - methods
Ligaments - abnormalities
Liver - blood supply
Liver cirrhosis
Liver Cirrhosis, Alcoholic - diagnosis
Liver Cirrhosis, Alcoholic - surgery
Liver Transplantation - adverse effects
Liver Transplantation - methods
Magnetic Resonance Angiography - methods
Male
Postoperative Complications - diagnosis
Postoperative Complications - surgery
Radiography
Reoperation - methods
Risk Assessment
Syndrome
Thrombosis
Transplants & implants
Ultrasonic imaging
Ultrasonography, Doppler
Vascular Patency - physiology
Veins & arteries
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Summary:The relevance of this fibrous band has been under debate since 1965 when Dunbar et al. first de- scribed a syndrome of postprandial abdominal pain and malabsorption secondary to celiac axis compres- sion by the median arcuate ligament.1 The relevance of this ligament in liver transplantation is widely ac- cepted because the ligament can cause a decrease in celiac artery blood flow leading to hepatic artery thrombosis in liver transplant recipients.2 This is often a lethal condition and the tendency may be to retransplant these patients immediately subjecting the patient to another life-threatening surgery with an unpredictable outcome. [...]recently, collateraliza- tion in the presence of hepatic artery thrombosis has been recognized as a distinctively later phenomenon taking 3 months to develop mature collaterals.3 In the setting of median arcuate ligament syndrome, this delayed development of collaterals may be too late to save the graft and save the patient.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313481007600905