Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary Management—A Narrative Review
Median Arcuate Ligament Syndrome, also known as Dunbar’s syndrome, is a rare condition caused by stenosis of the celiac artery (CAS) through the fibrous arch connecting the diaphragmatic branches. It manifests as postprandial abdominal pain, nausea, vomiting, weight loss and increased epigastric ten...
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MDPI AG
2025-03-01
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| Series: | Journal of Vascular Diseases |
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| author | Patryk Skórka Jacek Szulc Konrad Szewczyk Adam Szafirowski Piotr Gutowski Maciej Wojtuń Paweł Rynio |
| author_facet | Patryk Skórka Jacek Szulc Konrad Szewczyk Adam Szafirowski Piotr Gutowski Maciej Wojtuń Paweł Rynio |
| author_sort | Patryk Skórka |
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| description | Median Arcuate Ligament Syndrome, also known as Dunbar’s syndrome, is a rare condition caused by stenosis of the celiac artery (CAS) through the fibrous arch connecting the diaphragmatic branches. It manifests as postprandial abdominal pain, nausea, vomiting, weight loss and increased epigastric tenderness. The condition most commonly affects young females without coexisting vascular comorbidities. Diagnosis is difficult due to the non-specific symptoms, often overlapping with other gastrointestinal diseases. Standard investigations include duplex ultrasound, computed tomography angiography (CTA) and contrast-enhanced magnetic resonance imaging (CE-MRA). Treatment mainly consists of surgical release of the arch ligament, which can be performed by open, laparoscopic or robotic methods. Surgery is often supported by celiac truncal stenting for residual stenosis, which significantly improves vascular flow. Alternative approaches include visceral plexus blocks and novel hybrid techniques, such as a combination of ligament release and endovascular treatment of the celiac trunk. In severe cases, vascular by-passes are recommended. The aim of this paper is to discuss the clinical manifestations, diagnostic possibilities, therapeutic options and directions for further research on MALS from the perspective of a vascular surgeon. It emphasizes the need for a multidisciplinary approach, including collaboration between the surgeon, radiologist, gastroenterologist and psychologist, which enables comprehensive disease management and improved quality of life for patients. In addition, the need for further development of diagnostic and therapeutic methods for early diagnosis and effective treatment was pointed out. |
| format | Article |
| id | doaj-art-65745f6e5d3e4b43b9e11db7fca51c6d |
| institution | OA Journals |
| issn | 2813-2475 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | MDPI AG |
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| series | Journal of Vascular Diseases |
| spelling | doaj-art-65745f6e5d3e4b43b9e11db7fca51c6d2025-08-20T02:11:26ZengMDPI AGJournal of Vascular Diseases2813-24752025-03-01411110.3390/jvd4010011Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary Management—A Narrative ReviewPatryk Skórka0Jacek Szulc1Konrad Szewczyk2Adam Szafirowski3Piotr Gutowski4Maciej Wojtuń5Paweł Rynio6Department of Vascular Surgery and Angiology, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, PolandDepartment of Vascular Surgery and Angiology, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, PolandDepartment of Vascular Surgery and Angiology, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, PolandDepartment of Vascular Surgery and Angiology, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, PolandDepartment of Vascular Surgery and Angiology, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, PolandDepartment of General, Dental and Interventional Radiology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, PolandDepartment of Vascular Surgery and Angiology, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, PolandMedian Arcuate Ligament Syndrome, also known as Dunbar’s syndrome, is a rare condition caused by stenosis of the celiac artery (CAS) through the fibrous arch connecting the diaphragmatic branches. It manifests as postprandial abdominal pain, nausea, vomiting, weight loss and increased epigastric tenderness. The condition most commonly affects young females without coexisting vascular comorbidities. Diagnosis is difficult due to the non-specific symptoms, often overlapping with other gastrointestinal diseases. Standard investigations include duplex ultrasound, computed tomography angiography (CTA) and contrast-enhanced magnetic resonance imaging (CE-MRA). Treatment mainly consists of surgical release of the arch ligament, which can be performed by open, laparoscopic or robotic methods. Surgery is often supported by celiac truncal stenting for residual stenosis, which significantly improves vascular flow. Alternative approaches include visceral plexus blocks and novel hybrid techniques, such as a combination of ligament release and endovascular treatment of the celiac trunk. In severe cases, vascular by-passes are recommended. The aim of this paper is to discuss the clinical manifestations, diagnostic possibilities, therapeutic options and directions for further research on MALS from the perspective of a vascular surgeon. It emphasizes the need for a multidisciplinary approach, including collaboration between the surgeon, radiologist, gastroenterologist and psychologist, which enables comprehensive disease management and improved quality of life for patients. In addition, the need for further development of diagnostic and therapeutic methods for early diagnosis and effective treatment was pointed out.https://www.mdpi.com/2813-2475/4/1/11MALSceliac artery stenosisendovascular treatment |
| spellingShingle | Patryk Skórka Jacek Szulc Konrad Szewczyk Adam Szafirowski Piotr Gutowski Maciej Wojtuń Paweł Rynio Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary Management—A Narrative Review Journal of Vascular Diseases MALS celiac artery stenosis endovascular treatment |
| title | Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary Management—A Narrative Review |
| title_full | Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary Management—A Narrative Review |
| title_fullStr | Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary Management—A Narrative Review |
| title_full_unstemmed | Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary Management—A Narrative Review |
| title_short | Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary Management—A Narrative Review |
| title_sort | median arcuate ligament syndrome from diagnosis to multidisciplinary management a narrative review |
| topic | MALS celiac artery stenosis endovascular treatment |
| url | https://www.mdpi.com/2813-2475/4/1/11 |
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