What is the treatment for severe stenosis of the proximal celiac artery (CA)?

From the Guidelines

Treatment of severe stenosis of the proximal celiac artery should involve a multidisciplinary approach, with surgical release of the median arcuate ligament (MAL) accompanied by endovascular placement of a stent within the celiac artery if there is residual stenosis of >30%. This approach is supported by the most recent evidence from the 2022 update of the ACR Appropriateness Criteria for radiologic management of mesenteric ischemia 1. The use of percutaneous transluminal angioplasty with stent placement has been shown to be effective in restoring blood flow and relieving symptoms. Key considerations in the treatment of severe stenosis of the proximal celiac artery include:

• The importance of addressing the underlying extrinsic compression and chronic changes to the vessel wall from repeated stress
• The potential benefits of a multidisciplinary approach, including surgical release of the MAL and endovascular intervention
• The need for individualized treatment decisions based on symptom severity, comorbidities, and anatomical considerations
• The use of stenting or surgical bypass as needed following surgical release, with reported high rates of symptomatic relief and freedom from reintervention 1.

From the Research

Treatment Options for Severe Stenosis of Proximal Celiac Artery

• Severe stenosis of the proximal celiac artery can be treated with various methods, including:
  • Open surgery for decompression 2
  • Stenting 2, 3, 4, 5
  • Bypass grafting 2
  • Coil embolization for associated pancreaticoduodenal artery aneurysms 2
• The choice of treatment depends on the individual case and the presence of associated conditions, such as pancreaticoduodenal artery aneurysms or intestinal ischemia 2, 5
• Endovascular therapy, including stenting, has been shown to be effective in treating celiac and mesenteric arterial occlusive disease, with a low incidence of complications and a high technical success rate 4
• However, stent-associated thrombosis can occur, and restenosis may require additional interventions 2, 4
• Management of celiac axis stenosis is multidisciplinary and may involve interventional radiologists, gastrointestinal surgeons, vascular surgeons, and medical physicians 6