From the Guidelines
Celiac artery stenosis should be treated with surgical release of the median arcuate ligament (MAL) and subsequent reconstruction of the celiac artery, if necessary, to provide complete symptomatic relief and prevent complications. This approach is supported by a study published in the Journal of the American College of Radiology in 2022, which reported that surgical release of the MAL resulted in symptomatic relief in 84.6% of patients, and subsequent reconstruction of the celiac artery led to complete resolution of symptoms in 75% of patients at 6 months 1.
Treatment Options
- Surgical release of the MAL is a beneficial treatment option for celiac artery stenosis, with or without subsequent reconstruction of the celiac artery.
- Endovascular stenting may be performed after surgical release of the MAL if there is residual stenosis of the celiac artery of >30% 1.
- Medical management focuses on addressing risk factors with antiplatelet therapy, statins, blood pressure control, and lifestyle modifications.
Key Considerations
- The decision to reconstruct the celiac artery remains debatable, with some studies showing no significant difference in symptom relief or reintervention rates between patients who underwent decompression alone and those who received decompression with vascular reconstruction 1.
- A multidisciplinary approach advocating stenting or surgical bypass as needed following surgical release suggests high rates of symptomatic relief and freedom from reintervention 1.
- Regular follow-up with vascular ultrasound every 6-12 months is essential to monitor stent patency or disease progression.
Patient Education
- Patients should be aware of symptoms requiring immediate attention, such as severe abdominal pain after eating, significant weight loss, or signs of intestinal ischemia.
- Lifestyle modifications, including smoking cessation, regular exercise, and a heart-healthy diet, are crucial in managing celiac artery stenosis.
From the Research
Celiac Artery Stenosis Overview
- Celiac artery stenosis is a condition where the celiac artery, which supplies blood to the upper abdomen, becomes narrowed or blocked.
- This condition can be caused by various factors, including atherosclerosis, median arcuate ligament syndrome, and other diseases.
Symptoms and Diagnosis
- Symptoms of celiac artery stenosis may include postprandial pain, weight loss, and abdominal bruit.
- Diagnosis can be made using imaging techniques such as computed tomography angiogram, magnetic resonance angiography, and duplex ultrasound 2.
- Angiography can also be used to confirm the diagnosis and evaluate the severity of the stenosis 3, 4.
Treatment Options
- Treatment options for celiac artery stenosis include percutaneous transluminal angioplasty (PTA) and stent placement 3, 4, 5.
- Open surgery, such as decompression or bypass grafting, may also be considered in some cases 6.
- Coil embolization can be used to treat pancreaticoduodenal artery aneurysms associated with celiac stenosis 6.
- Management of celiac artery stenosis requires a multidisciplinary approach, involving interventional radiologists, gastrointestinal surgeons, vascular surgeons, and medical physicians 2.
Outcomes and Complications
- Outcomes of treatment for celiac artery stenosis can be favorable, with improvement in symptoms and prevention of further complications 3, 4, 5.
- However, complications such as stent-associated thrombosis and restenosis can occur 6.
- Long-term follow-up is necessary to monitor for potential complications and ensure the patency of the stented artery 5.