OBJECTIVE: The authors assessed the prevalence and clinical significance of the celiac compression syndrome in liver transplantation patients. SUMMARY BACKGROUND DATA: Compression of the celiac axis by the median arcuate ligament of the diaphragm, causes a decrease in celiac artery blood flow which may lead to hepatic artery thrombosis in patients undergoing orthotopic liver transplantation. METHODS: From July 1991 to July 1992, 17 (10%) cases of celiac compression syndrome were identified among 164 consecutive adult patients who underwent liver transplantation. The diagnosis was confirmed by blood flow recording demonstrating a typical pattern of accentuated decrease in celiac blood flow during expiration. RESULTS: Surgical transection of the median arcuate ligament resulted in normalization of the hepatic artery blood flow. In two cases (11.7%), an interposition iliac graft from the recipient supra-celiac aorta was used for the arterial reconstruction. During the follow-up period of up to 15 months, there was no incidence of hepatic artery thrombosis. CONCLUSIONS: The clinical significance of the celiac compression syndrome is evident in liver transplantation in which the collateral circulation to the liver is compromised and the celiac artery remains the only source of arterial blood. It is imperative to identify and remove the obstruction of the celiac axis to prevent severe complications and potential graft loss.
OBJECTIVE: The authors assessed the prevalence and clinical significance of the celiac compression syndrome in liver transplantation patients. SUMMARY BACKGROUND DATA: Compression of the celiac axis by the median arcuate ligament of the diaphragm, causes a decrease in celiac artery blood flow which may lead to hepatic artery thrombosis in patients undergoing orthotopic liver transplantation. METHODS: From July 1991 to July 1992, 17 (10%) cases of celiac compression syndrome were identified among 164 consecutive adult patients who underwent liver transplantation. The diagnosis was confirmed by blood flow recording demonstrating a typical pattern of accentuated decrease in celiac blood flow during expiration. RESULTS: Surgical transection of the median arcuate ligament resulted in normalization of the hepatic artery blood flow. In two cases (11.7%), an interposition iliac graft from the recipient supra-celiac aorta was used for the arterial reconstruction. During the follow-up period of up to 15 months, there was no incidence of hepatic artery thrombosis. CONCLUSIONS: The clinical significance of the celiac compression syndrome is evident in liver transplantation in which the collateral circulation to the liver is compromised and the celiac artery remains the only source of arterial blood. It is imperative to identify and remove the obstruction of the celiac axis to prevent severe complications and potential graft loss.
Authors: Ronald W Busuttil; Douglas G Farmer; Hasan Yersiz; Jonathan R Hiatt; Sue V McDiarmid; Leonard I Goldstein; Sammy Saab; Steven Han; Francisco Durazo; Michael Weaver; Carlos Cao; Tony Chen; Gerald S Lipshutz; Curtis Holt; Sherilyn Gordon; Jeffery Gornbein; Farin Amersi; Rafik M Ghobrial Journal: Ann Surg Date: 2005-06 Impact factor: 12.969
Authors: Sascha A Müller; Bruno M Schmied; Arianeb Mehrabi; Thilo Welsch; Peter Schemmer; Ulf Hinz; Jürgen Weitz; Jens Werner; Markus W Büchler; Jan Schmidt Journal: J Gastrointest Surg Date: 2008-11-26 Impact factor: 3.452
Authors: Mario Sianesi; Paolo Soliani; Maria Francesca Arcuri; Lamia Bezer; Gioacchino Iapichino; Paolo Del Rio Journal: Dig Dis Sci Date: 2006-12-08 Impact factor: 3.487