The median arcuate ligament is a band of hard tissue connecting the diaphragm to the spine. In median arcuate ligament syndrome (MALS), the ligament compresses the celiac artery, which supplies blood to the stomach, liver, and spleen. This is a rare condition, but it can lead to pain in the upper abdomen and may slow blood flow to the abdominal organs.

Symptoms of MALS include:

• Upper abdominal pain
• Nausea
• Diarrhea
• No symptoms

Symptoms can worsen after rapid weight loss.

Women aged 20 to 40 are more likely to experience MALS.

Rapid weight loss and certain anatomical factors may increase the risk for MALS.

Talk to a Doctor 

If a patient has any of the symptoms described, they should talk to their healthcare provider. The provider may order a gastrointestinal workup, which can indicate MALS or arterial compromise. If MALS or arterial compromise is suspected, referral to a vascular surgeon is necessary.  

Role of Vascular Surgeon 

Vascular surgeons diagnose and treat MALS, interpret imaging studies, and assess blood flow to abdominal organs. They collaborate with other specialists for optimal patient treatment, including laparoscopic; robotic ligament release; and arterial interventions, such as ballooning or stenting. 

Diagnosis 

Diagnostic tools for MALS include Doppler ultrasounds, CT scans, MRI, angiograms, and nerve blocks to assess symptoms. Vascular surgeons use these tests to confirm the diagnosis and determine the underlying cause of symptoms. 

Treatment for MALS may involve laparoscopic or robotic ligament release, performed by non-vascular surgeons. Vascular surgeons may recommend additional arterial interventions such as ballooning, stenting, or open surgery if necessary. Collaboration among all the patient’s health care providers ensures the best possible outcomes.