Factors Associated With Successful Median Arcuate Ligament Release in an International, Multi-Institutional Cohort. Journal Article

Local Library Link: Find It @ Loyola

Authors: DeCarlo, C; Woo, K; van Petersen, AS; Geelkerken, R; Chen, AJ; Yeh, SL; Kim, GY; Henke, PK; Tracci, MC; Schneck, MB; Grotemeyer, D; Meyer, B; DeMartino, RR; Wilkins, PB; Iranmanesh, S; Rastogi, V; Aulivola, B; Korepta, LM; Shutze, WP; Jett, KG; Sorber, R; Abularrage, CJ; Long, GW; Bove, PG; Davies, MG; Miserlis, D; Shih, M; Yi, J; Gupta, R; Loa, J; Robinson, DA; Gombert, A; Doukas, P; de Caridi, G; Benedetto, F; Wittgen, CM; Smeds, MR; Sumpio, BE; Harris, S; Szeberin, Z; Pomozi, E; Stilo, F; Montelione, N; Mouawad, NJ; Lawrence, P; Dua, A
Article Title: Factors Associated With Successful Median Arcuate Ligament Release in an International, Multi-Institutional Cohort.
Abstract: OBJECTIVES: Prior research on median arcuate ligament syndrome (MALS) is limited to institutional case series, making the optimal approach to median arcuate ligament release (MALR) and resulting outcomes unclear. This study aimed to compare the outcomes of approaches to MALR and determine predictors of long-term treatment failure. METHODS: The Vascular Low Frequency Disease Consortium (VLFDC) is an international, multi-institutional research consortium. Data on open, laparoscopic, and robotic MALR performed from 2000-2020 were gathered. The primary outcome was treatment failure, defined as no improvement in MALS symptoms after MALR or recurrence of symptoms between MALR and last clinical follow-up. RESULTS: For 516 patients treated at 24 institutions, open MALR was performed in 227 (44.0%), laparoscopic in 235 (45.5%), and robotic in 54 (10.5%) patients. Perioperative complications (ileus, cardiac, wound complications, readmission, unplanned procedures) occurred in 19.2% (open 30.0% vs. laparoscopic 8.9% vs. robotic 18.5%; p0.001). Median follow-up was 1.59 years (IQR: 0.38-4.35 years). For the 488 patients with follow-up data, 287 (58.8%) had full relief, 119 (24.4%) had partial relief, and 82 (16.8%) derived no benefit from MALR. The one- and three-year freedom from treatment failure for the overall cohort was 63.8% (95% CI: 59.0%-68.3%) and 51.9% (95% CI: 46.1%-57.3%), respectively. Factors associated with an increased hazard of treatment failure on multivariable analysis included robotic MALR (HR 1.73; 95% CI: 1.16-2.59; p=0.007), a history of gastroparesis (HR 1.83; 95% CI: 1.09-3.09; p=0.023), abdominal cancer (HR 10.3; 95% CI: 3.06-34.6; p0.001), dysphagia/odynophagia (HR 2.44; 95% CI: 1.27-4.69; p=0.008), no relief from a celiac plexus block (HR 2.18; 95% CI: 1.00-4.72; p=0.049), and increasing number of preoperative pain locations (HR 1.12 per location; 95% CI: 1.00-1.25; p=0.042); factors associated with a lower hazard included increasing age (HR 0.99 per increasing year; 95% CI: 0.98-1.0; p=0.012) and an increasing number of preoperative diagnostic gastrointestinal studies (HR 0.84 per study; 95% CI: 0.74-0.96; p=0.012) Open and laparoscopic MALR had similar long-term freedom from treatment failure. No radiographic parameters were associated with differences in treatment failure. CONCLUSION: There is no difference in long-term failure after open versus laparoscopic MALR, but open release is associated with higher perioperative morbidity. These results support the use of preoperative celiac plexus block to aid in patient selection. Operative candidates for MALR should be counseled on the factors associated with treatment failure and the relatively high overall rate of treatment failure.
Journal Title: Journal of vascular surgery
ISSN: 1097-6809; 0741-5214
Publisher: Mosby, Inc  
Date Published: 2022