43 Late Results Following Operative Repair for Celiac Artery Compression Syndrome скачать в хорошем качестве

43 Late Results Following Operative Repair for Celiac Artery Compression Syndrome

#CELIACCESSIONSYNDROME #MALS #MedianArcuateLigamentSyndrome #VascularSurgery #RileyStudy #JournalOfVascularSurgery #SurgicalOutcomes #CECS #AbdominalPain #PostprandialPain This video discusses the landmark 1985 study by Riley and colleagues published in the Journal of Vascular Surgery. It examined the late results of surgery for symptomatic celiac artery compression syndrome (CECS), also known as median arcuate ligament syndrome (MALS). Back in the mid-80s, MALS was a diagnostic puzzle, partly because the physical compression seen on imaging didn't always cause symptoms, and the exact cause of pain was unclear. The study was a retrospective, single-centre review of 51 patients who had surgery for symptomatic CECS. A key strength was the significant long-term follow-up, averaging nine years, with 86% of patients tracked. Patients underwent different operations: decompression alone (releasing the ligament and some nerves), decompression plus surgical dilatation, or decompression plus arterial reconstruction (like bypass or primary repair). The major finding was that overall, 68% of patients were asymptomatic long-term. Crucially, outcomes were significantly better when patients had decompression plus revascularization (dilatation or reconstruction), with 76% becoming asymptomatic compared to only 53% with decompression alone. Late follow-up arteriograms showed a strong link between an open celiac artery and symptom relief. The study also identified predictors of better outcomes, including classic postprandial pain, age 40-60, and significant weight loss (20 pounds). Factors linked to less success included atypical pain patterns, psychiatric history, and age over 60. Riley's paper was highly influential, providing the first clear evidence that surgery could work for MALS and highlighting the importance of restoring blood flow. While foundational and cited as a cornerstone, it also revealed that complete relief isn't guaranteed, and patient selection remains challenging. The study strongly suggested arterial insufficiency (blood flow issues) was a key pain mechanism, though the exact cause is still debated today. Modern approaches include minimally invasive ligament release, though outcomes can still be variable.