The impact of psychiatric comorbidities on patient-reported surgical outcomes in adults treated for the median arcuate ligament syndrome

J Vasc Surg. 2018 Nov;68(5):1414-1421. doi: 10.1016/j.jvs.2017.12.078. Epub 2018 Jul 29.


Objective: Median arcuate ligament syndrome (MALS) is an often overlooked, surgically correctable condition that mimics functional chronic abdominal pain. Patient-reported surgical outcomes are unpredictable in MALS. The objective of this study was to define the psychiatric comorbidities in a cohort of adults undergoing surgery for MALS and to determine whether these comorbidities are predictive of patient-reported quality of life (QOL) outcomes.

Methods: A prospective observational trial was conducted between April 1, 2010, and December 31, 2015, at a single tertiary care hospital. Adults with a diagnosis of chronic abdominal pain in the setting of celiac artery compression were enrolled in a prospective Institutional Review Board-approved observational trial. Patients completed psychological assessments before surgery for MALS and at 6 months after surgery. The primary outcome was patient-reported health-related QOL (young adult version of the Pediatric Quality of Life Inventory).

Results: A total of 51 patients (80% female; n = 41) with a mean age of 30.5 (±12.4) years were enrolled. Surgery significantly improved celiac artery hemodynamics in the entire cohort (P < .0001) as well as overall QOL (67.8 ± 14.6 [before surgery] vs 80.3 ± 13.7 [after surgery]; P < .001). Psychiatric diagnoses were common in this cohort, with 14 of 51 (28%) patients meeting criteria for a psychiatric diagnosis. There were no differences in the number of patients with psychiatric diagnoses between presurgical and postsurgical evaluations (14 [28%] vs 13 [26%]; P = .8). Exploratory analyses suggest that having a psychiatric diagnosis at the presurgical evaluation may predict significantly lower postsurgical QOL (R2 = 0.009; P = .01).

Conclusions: Surgery improves patient-reported QOL in adults treated for MALS. Psychiatric diagnoses are common in adults with MALS and predict worse patient-reported QOL outcomes.

Keywords: Celiac artery; Celiac artery compression; Chronic abdominal pain; Median arcuate ligament syndrome; Mesenteric ischemia; Patient-reported outcomes; Psychological comorbidities; Quality of life.

Publication types

  • Observational Study

MeSH terms

  • Abdominal Pain / epidemiology
  • Abdominal Pain / psychology
  • Adolescent
  • Adult
  • Chronic Pain / epidemiology
  • Chronic Pain / psychology
  • Comorbidity
  • Cost of Illness
  • Female
  • Humans
  • Male
  • Median Arcuate Ligament Syndrome / diagnosis
  • Median Arcuate Ligament Syndrome / epidemiology
  • Median Arcuate Ligament Syndrome / psychology
  • Median Arcuate Ligament Syndrome / surgery*
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology
  • Mental Disorders / psychology*
  • Mental Health
  • Pain Measurement
  • Patient Reported Outcome Measures*
  • Prospective Studies
  • Quality of Life*
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Surgical Procedures* / adverse effects
  • Young Adult