Clinical Indications for Celiac Artery Origin Stenosis Due to Arcuate Ligament Prominence
The classic clinical presentation of celiac artery stenosis due to median arcuate ligament compression includes postprandial abdominal pain, nausea and vomiting that worsens after meals, and fear of eating (sitophobia). 1
Key Clinical Symptoms and Presentation
- Postprandial abdominal pain occurring 30-60 minutes after food consumption is a hallmark symptom of celiac artery compression syndrome 2, 1
- Weight loss is a significant clinical indicator, with weight loss of 20 pounds or more associated with a 67% cure rate following intervention 1
- Food avoidance (sitophobia) due to fear of triggering pain is commonly reported 2, 1
- Nausea, vomiting, postprandial diarrhea, and early satiety may also be present in patients with celiac artery stenosis 2
- Symptoms are typically chronic rather than acute in nature 2
Physical Examination Findings
- An abdominal bruit in the upper mid-epigastrium may be detected on physical examination 3
- The pain is often exacerbated by position changes, particularly those that compress the celiac axis 1
- Patients aged between 40-60 years have better response rates to intervention (77% cure rate), suggesting this age group may have more clinically significant stenosis 1
Diagnostic Considerations
- Celiac artery compression is present in approximately 20% of the general population but is not always symptomatic, making clinical correlation essential 1, 4
- Stenosis >50% at the origin of the celiac axis is found in about 3.4% of asymptomatic individuals, highlighting the importance of correlating imaging findings with symptoms 4
- The condition is a diagnosis of exclusion, requiring thorough evaluation to rule out other causes of abdominal pain 5
Associated Complications
- Pancreaticoduodenal artery aneurysms may develop as a compensatory response to chronic celiac axis stenosis 6
- Chronic mesenteric ischemia can result from prolonged compression of the celiac artery 5
- Malabsorption signs may be present in advanced cases 2
Imaging Indications
- CTA of the abdomen and pelvis is the preferred initial imaging modality with 95-100% sensitivity and specificity for detecting median arcuate ligament syndrome 2, 1
- The "J-shaped" or "hook" configuration of the celiac artery on sagittal images is considered characteristic, though this may also be seen in normal anatomy 1, 7, 4
- Axial images may demonstrate higher degree stenosis than sagittal views in some cases 7
- Duplex ultrasound can be used as a screening tool, with peak systolic velocity >240 cm/s suggesting significant celiac artery stenosis 2
Predictors of Successful Treatment Outcomes
- Postprandial pain pattern is associated with an 81% cure rate following intervention 1
- Age between 40-60 years correlates with a 77% success rate after treatment 1
- Significant weight loss (≥20 pounds) predicts a 67% likelihood of symptom resolution with appropriate intervention 1
- Celiac plexus block may serve as both a diagnostic tool and predictor of surgical outcomes in suspected cases 5
Pitfalls and Caveats
- Not all patients with imaging evidence of celiac compression are symptomatic, as compression may be a normal finding in up to 20% of the population 1
- Alternative diagnoses should be considered if symptoms persist after intervention 1
- Endovascular intervention alone (without surgical release) is not recommended due to risk of stent fracture or migration from persistent extrinsic compression 1