The median arcuate ligament may compress the proximal celiac artery and cause stenosis. Sugae et al developed a classification system for grading the severity of celiac axis stenosis in these patients.
The authors are from Nagoya University in Japan.
Patient selection: median arcuate ligament compressing the proximal celiac artery
Parameters:
(1) percent stenosis
(2) length of stenosis in mm
(3) distance from the aorta in mm
Percent Stenosis
Length of Stenosis
Distance from Aorta
Type
<= 50%
<= 3 mm
>= 5 mm
A
50 to 80%
3 to 8 mm
>= 5 mm
B
>= 80%
>= 8 mm
< 5 mm (short)
C
Type
Collateral Arteries
Management
A
none
not necessary
B
periampullary
median arcuate ligament division
C
periampullary region and around pancreatic tail; arcade from inferior PD to GD arteries
arterial reconstruction; preservation of collateral pathways
PD = pancreatoduodenal, GD = gastroduodenal
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