Inability of conventional imaging findings to predict response to laparoscopic release of the median arcuate ligament in patients with celiac artery compression
Inability of conventional imaging findings to predict response to laparoscopic release of the median arcuate ligament in patients with celiac artery compression
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DOI：
10.1016/j.jvs.2018.04.062
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发表时间：
2019-02-01
影响因子：
4.3
通讯作者：
Lorenz, Jonathan
中科院分区：
文献类型：
--
作者：
Patel, Mikin V.;Dalag, Leonard;Lorenz, Jonathan
目的：本研究的目的是确定双功超声（DUS）或计算机断层扫描血管造影（CTA）成像结果，可以预测腹腔镜下正中弓状韧带（MAL）腹腔动脉压迫患者的临床反应。方法：有299例患者在2009年1月至2015年11月期间接受了MAL综合征（MALS）的评估。其中，29例接受了腹腔镜MAL松解术，并完成了1年随访。记录患者的术前和术后症状、镇痛药的使用和体重指数。对患者的人口统计学资料以及DUS和CTA结果进行了审查。Fisher精确和学生t检验被用来确定患者或成像变量和临床outcome.Results之间的相关性：有19例（66%）谁报告症状改善，18（62%）减少了他们使用镇痛药;平均体重指数增加0.2（标准差，1.97;范围，-3.35至5.11）。没有腹腔动脉DUS发现（峰值腹腔动脉流速、偏转角或术前至术后流速的变化）可预测成功的临床结局（P > 0.05）。同样，CTA结果（腹腔动脉局灶性狭窄的特征性形态、横截面积、直径或位置）与临床结局无关（P > 0.05）。结论：三分之二的患者对腹腔镜MAL松解术的临床反应良好;然而，没有特异性狭窄影像学结果可预测这种反应。鉴于常规影像学显示狭窄的严重程度对治疗效果没有影响，血管损伤可能不是该综合征患者疼痛的主要原因。未来的研究结合MALS疼痛的神经原基础，如诊断性腹腔神经节阻滞，将有助于进一步阐明MALS神秘的病理生理过程。
Objective: The objective of this study was to identify duplex ultrasound (DUS) or computed tomography angiography (CTA) imaging findings that can predict clinical response to laparoscopic release of the median arcuate ligament (MAL) in patients with celiac artery compression.Methods: There were 299 patients who were evaluated for MAL syndrome (MALS) between January 2009 and November 2015. Of these, 29 underwent laparoscopic MAL release and completed 1-year follow-up. The patients' preoperative and postoperative symptoms, use of analgesics, and body mass index were recorded. Patients' demographics and DUS and CTA findings were reviewed. Fisher exact and Student t-tests were used to identify correlation between patient or imaging variables and clinical outcomes.Results: There were 19 patients (66%) who reported improvement in symptoms, and 18 (62%) decreased their use of analgesics; average body mass index increased by 0.2 (standard deviation, 1.97; range, -3.35 to 5.11). No celiac artery DUS finding (peak celiac artery velocity, angle of deflection, or change in preoperative to postoperative velocity) was predictive of successful clinical outcomes (P >.05). Similarly, no CTA finding (characteristic morphology, cross-sectional area, diameter, or location of the focal stenosis of the celiac artery) was associated with clinical outcomes (P >.05).Conclusions: Clinical response to laparoscopic MAL release was favorable in two-thirds of patients; however, no specific imaging finding of stenosis was predictive of this response. Given that the severity of stenosis on conventional imaging had no impact on treatment efficacy, vascular compromise may not be the primary cause of pain in patients presenting with this syndrome. Future investigation incorporating the neurogenic basis of MALS pain, such as with diagnostic celiac ganglion blockade, would be helpful in further elucidating the enigmatic pathophysiologic process of MALS.