Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon.
Department of Radiology, Stamford Hospital, Stamford, Connecticut.
J Vasc Interv Radiol. 2021 Jul;32(7):1081-1087. doi: 10.1016/j.jvir.2021.04.003. Epub 2021 Apr 13.
To evaluate the response of median arcuate ligament syndrome (MALS) symptoms, including postprandial pain, nausea, and vomiting, to celiac plexus block (CPB) and correlate the response with arterial anatomy.
In a single-institution, retrospective cohort of clinically diagnosed MALS patients, 96 patients (female, 75; male, 21; mean age, 27 years) underwent 103 computed tomography‒guided percutaneous CPB procedures. Imaging, procedural, and clinical reports were reviewed. Primary outcomes evaluated were technical success, change in self-reported pain score, and change in nausea and vomiting.
Computed tomography imaging before the procedure was available for 81 of 96 patients and demonstrated findings of celiac artery compression in 22 of 81 (27%) patients. Technical success was achieved in 102 of 103 cases. No major adverse events and 1 moderate adverse event were reported. The postprandial pain score decreased in 86 (84%) patients, and the mean score decreased from 6.3 to 0.9 points (P < .001). The prevalence of postprandial nausea decreased from 37.9% to 11.6% (P < .001) and that of vomiting decreased from 15.5% to 4.9% (P = .019). No differences were noted in pain relief after CPB between patients with and without celiac artery compression (P = .745).
In patients with a clinical diagnosis of MALS, a large majority reported pain relief and decreased gastrointestinal symptoms after CPB. Pain relief did not correlate with the presence of celiac arterial abnormalities. This supports neuropathy as the primary etiology of MALS and suggests that the absence of celiac stenosis should not be used as an exclusion criterion.
评估正中弓状韧带综合征（MALS）症状（包括餐后疼痛、恶心和呕吐）对腹腔神经丛阻滞（CPB）的反应，并将其与动脉解剖相关联。
在一家机构的回顾性临床诊断 MALS 患者队列中，96 名患者（女性 75 例，男性 21 例，平均年龄 27 岁）接受了 103 次计算机断层扫描引导的经皮 CPB 手术。对影像学、手术和临床报告进行了回顾。评估的主要结果是技术成功率、自我报告疼痛评分的变化以及恶心和呕吐的变化。
81 名患者中有 81 名患者的术前 CT 图像可用于评估，其中 22 名（27%）患者存在腹腔动脉压迫。103 例中有 102 例获得了技术成功。未报告重大不良事件，仅报告了 1 例中度不良事件。86 名（84%）患者的餐后疼痛评分降低，平均评分从 6.3 分降至 0.9 分（P <.001）。餐后恶心的发生率从 37.9%降至 11.6%（P <.001），呕吐的发生率从 15.5%降至 4.9%（P =.019）。在 CPB 后疼痛缓解方面，有和没有腹腔动脉压迫的患者之间没有差异（P =.745）。
在有临床诊断为 MALS 的患者中，绝大多数患者在接受 CPB 后报告疼痛缓解和胃肠道症状减轻。疼痛缓解与腹腔动脉异常的存在无关。这支持神经病作为 MALS 的主要病因，并表明不应将腹腔狭窄的缺失作为排除标准。
