From the Guidelines
The most effective treatment for celiac artery compression syndrome with respect to pain and celiac artery plexus blocks is a multidisciplinary approach, including celiac plexus blocks, conservative management, and surgical intervention, with the choice of treatment depending on symptom severity, patient comorbidities, and response to initial treatments, as recommended by the most recent and highest quality study 1.
Treatment Options
- Celiac plexus blocks can be effective for pain relief in CACS patients, involving injection of local anesthetics with or without steroids around the celiac plexus, as supported by a study on pancreatic cancer patients 1.
- Conservative management includes pain medications, dietary modifications, and postural changes to reduce compression.
- Definitive treatment often requires surgical intervention, typically laparoscopic release of the median arcuate ligament to decompress the celiac artery, as recommended by the ACR Appropriateness Criteria 1.
Celiac Plexus Blocks
- Can be performed under CT, ultrasound, or fluoroscopic guidance and may provide temporary relief lasting weeks to months.
- For longer-term pain control, neurolytic blocks using alcohol or phenol may be considered, though these carry higher risks of complications.
- The preferred way to carry out a celiac plexus block is via EUS guidance, as recommended by a study on interventional EUS procedures 1.
Surgical Intervention
- Laparoscopic release of the median arcuate ligament to decompress the celiac artery is the recommended surgical approach, as it addresses the root cause by relieving the mechanical compression and may include celiac ganglionectomy for additional pain relief.
- This approach is usually appropriate, with a rating of 8 on the ACR Appropriateness Criteria scale 1.
From the Research
Treatment for Celiac Artery Compression Syndrome
- The treatment for celiac artery compression syndrome (CACS) involves the division of the median arcuate ligament and celiac plexus fibers, which can be done through an open approach or a minimally invasive technique such as laparoscopic or endoscopic retroperitoneal approach 2, 3.
- The endoscopic retroperitoneal approach has been shown to be feasible and effective, with a primary-assisted anatomic patency rate of 89% and significant improvement in symptoms in 41 out of 46 patients 2.
- Laparoscopic decompression of the celiac artery is also a useful therapy for CACS, but it carries a potential risk of vascular injury and may require adjunctive celiac artery intervention 3.
Celiac Artery Plexus Blocks
- Celiac plexus block can be used as a diagnostic tool and a predictor of surgical outcomes for sympathetically mediated abdominal pain in suspected median arcuate ligament syndrome (MALS) or CACS 4.
- The block can help determine if the patient's pain is sympathetically mediated and if they are likely to benefit from surgical decompression of the celiac artery.
Pain Management
- Patients with CACS typically experience chronic abdominal pain, which can be managed with surgical decompression of the celiac artery or celiac plexus block 4, 5.
- The pain is often sympathetically mediated and can be relieved with division of the median arcuate ligament and celiac plexus fibers 2, 3.
- However, some patients may not experience significant improvement in pain after surgical treatment, and the role of primary stenting of celiac artery compression is still not well defined 6.