Median Arcuate Ligament Syndrome (MALS)

Hello ALL. So had my appointment last week with my Vascular Surgeon (Jenny Cho). First off Dr. Cho was very professional and was understanding. She went over my symptoms and decided to do a CT Scan. She looked over my ULTRASOUND and believes that since my open release in 2019 that my Celiac Artery has possibly closed. Either by scar tissue, or by the inner part of the artery is damaged. Along with my initial issue I was also diagnosed with May Thunder Syndrome. So Dr Cho stated depending on the severity of the artery she thought a stent would be a good option, and possibly a bypass. My question I would ask. Has anyone had a stent or a bypass and if so which one would be better than the other. Also, does anyone have May Thunder Syndrome?

Thanks

There is a woman on the MALS Pals group on Facebook, Robin Schrader, who has had a similar experience of open surgery (2 actually) followed by the artery collapsing from years of compression. I believe she had stents done and then a bypass or is waiting for a bypass. I would think they need to figure out if you have re-compression from scar tissue before deciding what to do (hopefully CTA will show what's going on). If you have re-compression you'll probably need another surgery (just what happened to me) because a stent would likely fail. If the artery has failed but there is no compression then a stent is a great option and would avoid another surgery.

Unfortunately I know nothing about May Turner but it is discussed quite a bit on the MALS groups on Facebook.

@jayson - I had a stent placed 6 months after surgery to release the ligament. The artery had remained in the compressed shape. Before the stent placement, the surgeon explained that if the stent fails the next step would be open bypass.
6 years later the stent is still working. The deformed artery has put a little pressure on the stent, but it has remained functional.

Here’s what my leg looked like after a week. It was swollen and blue.

Thanks so much. I feel the stent will help, however I’m just worried with the scar tissue being the possible issue. I’m going in on the 21 of April for a CT scan to see how everything is working. Also, they’re going to look at my iliac artery to see how bad it is an if it needs a stent also. Hence the May Thunder Syndrome. So I’m hopeful and worried at the same time. I have two beautiful grand babies that I want to be able to run around with lol. Again thanks to everyone on here, it helps for us who have been through a lot.

Thank you. I’m hoping for just a stent and not another surgery. My original surgeon hasn’t had to go back in twice. So he’s a little nervous I’m doing it again. Mention it’s very risky and I would be on the table for at least 8 hrs unlike the 4 hour surgery to release the ligament. The May Thunder Syndrome has me wondering if it ties in with my compression issue.

Wishing you well! I would really like to hear from you after testing and discussion.

I will definitely keep everyone updated. And thanks to everyone’s help.

This is my results from my current CT scan.

Study Result
Impression
Status post surgical decompression of median arcuate ligament syndrome with persistent, mild narrowing of the proximal celiac artery and mild poststenotic dilation. The abdominal aorta and its major branch vessels are otherwise unremarkable without significant atherosclerotic disease or stenosis.
CTA of the abdomen and pelvis

CLINICAL HISTORY: Celiac artery stenosis; median arcuate ligament syndrome. Status post surgical decompression of median arcuate ligament syndrome in 2019

TECHNIQUE: Multiple contiguous axial images were obtained through the abdomen and pelvis after the IV administration of Omnipaque 350 contrast material. Image postprocessing coronal, sagittal, and three-dimensional reconstructions were obtained from the source axial data.

COMPARISON: No previous

FINDINGS:

Lower thorax: The visualized portions of the lower thorax are grossly unremarkable.

Liver and biliary system: A portion of the hepatic dome is excluded from the field-of-view. The visualized portions of the liver are unremarkable. There is no biliary ductal dilation.

Spleen: Unremarkable

Adrenal glands and kidneys: Unremarkable

Pancreas and retroperitoneum: Pancreas unremarkable. No retroperitoneal lymphadenopathy.

Abdominal aorta and major vessels: The abdominal aorta and iliac arteries are normal in caliber containing no significant atherosclerotic plaque. The origin of the celiac artery is patent. There is narrowing of the proximal celiac artery measuring up to 0.5 cm in diameter. Mild poststenotic dilation is present within the more distal portions of the celiac artery measuring up to 1 cm in diameter. The superior mesenteric and single bilateral renal arteries are widely patent. Flow is preserved within the inferior mesenteric artery.

Bowel, mesentery, and peritoneal space: Mild scarring and a focus of dystrophic calcification are noted within the omental fat, as demonstrated in images 2/15 through 17, likely postoperative in nature related to the patient's prior median arcuate ligament decompression. The bowel loops are nondistended. The appendix is unremarkable. There is no ascites.

Pelvis: Unremarkable

Osseous structures and body wall: No destructive osseous lesion.

Not sure what this all means. Waiting for my Vascular Surgeon to talk with me about the findings.

Thanks for the entire report! First- I don’t know your age, but you don’t have any atherosclerosis !
You seem to have what I had- artery still staying in compressed position. Your iliac arteries are normal.
Your doctor will have to decide what to recommend in this situation. I hope a stent would help open up the artery more. Keep your fingers crossed!
Would like to hear what your vascular surgeon says.