Factors associated with successful median arcuate ligament release in an international, multi-institutional cohort

Prior research on median arcuate ligament syndrome has been limited to institutional case series, making the optimal approach to median arcuate ligament release (MALR) and resulting outcomes unclear. In the present study, we compared the outcomes of different approaches to MALR and determined the pr...

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Published in:Journal of vascular surgery 2023-02, Vol.77 (2), p.567-577.e2
Main Authors: DeCarlo, Charles, Woo, Karen, van Petersen, André S., Geelkerken, Robert H., Chen, Alina J., Yeh, Savannah L., Kim, Gloria Y., Henke, Peter K., Tracci, Margaret C., Schneck, Matthew B., Grotemeyer, Dirk, Meyer, Bernd, DeMartino, Randall R., Wilkins, Parvathi B., Iranmanesh, Sina, Rastogi, Vinamr, Aulivola, Bernadette, Korepta, Lindsey M., Shutze, William P., Jett, Kimble G., Sorber, Rebecca, Abularrage, Christopher J., Long, Graham W., Bove, Paul G., Davies, Mark G., Miserlis, Dimitrios, Shih, Michael, Yi, Jeniann, Gupta, Ryan, Loa, Jacky, Robinson, David A., Gombert, Alexander, Doukas, Panagiotis, de Caridi, Giovanni, Benedetto, Filippo, Wittgen, Catherine M., Smeds, Matthew R., Sumpio, Bauer E., Harris, Sean, Szeberin, Zoltan, Pomozi, Enikő, Stilo, Francesco, Montelione, Nunzio, Mouawad, Nicolas J., Lawrence, Peter, Dua, Anahita
Format: Article
Language:English
Subjects:
Abdominal Pain - etiology
Celiac Artery - diagnostic imaging
Celiac Artery - surgery
Humans
Laparoscopy - adverse effects
Ligaments - surgery
MALS
Median arcuate ligament release
Median arcuate ligament syndrome
Median Arcuate Ligament Syndrome - complications
Median Arcuate Ligament Syndrome - diagnostic imaging
Median Arcuate Ligament Syndrome - surgery
Treatment Failure
Vascular Low Frequency Disease Consortium
VLFDC
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Summary:Prior research on median arcuate ligament syndrome has been limited to institutional case series, making the optimal approach to median arcuate ligament release (MALR) and resulting outcomes unclear. In the present study, we compared the outcomes of different approaches to MALR and determined the predictors of long-term treatment failure. The Vascular Low Frequency Disease Consortium is an international, multi-institutional research consortium. Data on open, laparoscopic, and robotic MALR performed from 2000 to 2020 were gathered. The primary outcome was treatment failure, defined as no improvement in median arcuate ligament syndrome symptoms after MALR or symptom recurrence between MALR and the last clinical follow-up. For 516 patients treated at 24 institutions, open, laparoscopic, and robotic MALR had been performed in 227 (44.0%), 235 (45.5%), and 54 (10.5%) patients, respectively. Perioperative complications (ileus, cardiac, and wound complications; readmissions; unplanned procedures) occurred in 19.2% (open, 30.0%; laparoscopic, 8.9%; robotic, 18.5%; P < .001). The median follow-up was 1.59 years (interquartile range, 0.38-4.35 years). For the 488 patients with follow-up data available, 287 (58.8%) had had full relief, 119 (24.4%) had had partial relief, and 82 (16.8%) had derived no benefit from MALR. The 1- and 3-year freedom from treatment failure for the overall cohort was 63.8% (95% confidence interval [CI], 59.0%-68.3%) and 51.9% (95% CI, 46.1%-57.3%), respectively. The factors associated with an increased hazard of treatment failure on multivariable analysis included robotic MALR (hazard ratio [HR], 1.73; 95% CI, 1.16-2.59; P = .007), a history of gastroparesis (HR, 1.83; 95% CI, 1.09-3.09; P = .023), abdominal cancer (HR, 10.3; 95% CI, 3.06-34.6; P < .001), dysphagia and/or odynophagia (HR, 2.44; 95% CI, 1.27-4.69; P = .008), no relief from a celiac plexus block (HR, 2.18; 95% CI, 1.00-4.72; P = .049), and an increasing number of preoperative pain locations (HR, 1.12 per location; 95% CI, 1.00-1.25; P = .042). The factors associated with a lower hazard included increasing age (HR, 0.99 per increasing year; 95% CI, 0.98-1.0; P = .012) and an increasing number of preoperative diagnostic gastrointestinal studies (HR, 0.84 per study; 95% CI, 0.74-0.96; P = .012) Open and laparoscopic MALR resulted in similar long-term freedom from treatment failure. No radiographic parameters were associated with differences in treatment failure. No difference wa
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2022.10.022