Abstract：
Introduction: Median Arcuate Ligament Syndrome (MALS) is associated with true aneurysms, mainly of both the pancreaticoduodenal artery (PDA) and gastroduodenal artery (GDA). Although rare, their potential for rupture and adverse clinical outcomes warrants analysis. Prior studies suggest high rupture rates even for smaller aneurysms under 2 cm in this setting. We performed a systematic literature review, synthesising the evidence on visceral artery aneurysms related to MAL syndrome, with a focus on descriptive analyses of aneurysm size, presentation, rupture rates, and management. Methods: Literature search was performed using (Medline, EMBASE, Emcare and CINAHL). Inclusion criteria included true aneurysms secondary to MALS with or without rupture. The cases with pseudoaneurysms, concomitant pathologies eg, pancreatitis, conservatively managed aneurysms and articles with non-granular pooled data were excluded. Cases were assessed according to demographics, clinical presentation, aneurysm diameter, aneurysm rupture and management technique. Results: 39 articles describing 72 patients were identified. Aneurysm diameter in symptomatic patients was not significantly different from asymptomatic patients {21.0 and 22.3 mm respectively, P = .84}. Ruptured aneurysms were overall smaller than non-ruptured at presentation {12.3 mm v 30.8 mm respectively, P = .02}. Patients presented with abdominal pain (75.6%), nausea/vomiting (15.6%), hypotension (33.9%), shock (20.0%) and haemodynamic collapse (8.9%). 56.9% of all cases were managed with an endovascular approach, 19.4% were managed with an open surgical approach, and 23.6% were managed hybrid. Conclusion: This review suggests visceral artery aneurysms associated with median arcuate ligament rupture at variable sizes. Despite inability to clearly correlate size and rupture risk, our data supports prompt intervention irrespective of size, given the adverse outcomes. Further research is critically needed to clarify size thresholds or other predictors to guide management.
摘要：
简介：正中弓状韧带综合征（MALS）与真正的动脉瘤有关，主要见于胰十二指肠动脉(PDA)和胃十二指肠动脉(GDA)。虽然罕见，其破裂和不良临床结局的可能性值得分析.先前的研究表明，在这种情况下，即使对于2厘米以下的较小动脉瘤，破裂率也很高。我们进行了系统的文献综述，合成与MAL综合征相关的内脏动脉瘤的证据，专注于动脉瘤大小的描述性分析，介绍,破裂率,和管理。方法：使用(Medline，EMBASE,护理和CINAHL）。纳入标准包括继发于MALS的真实动脉瘤，有无破裂。假性动脉瘤的病例，伴随的病理，例如，胰腺炎,保守管理的动脉瘤和非颗粒合并数据的文章被排除.根据人口统计学评估病例，临床表现,动脉瘤直径，动脉瘤破裂和处理技术。结果：确定了39篇描述72例患者的文章。有症状患者的动脉瘤直径与无症状患者{21.0和22.3mm无显著差异，P=.84}。出现时破裂的动脉瘤总体上小于未破裂的动脉瘤{12.3mmv30.8mm，P=.02}。患者出现腹痛（75.6%），恶心/呕吐（15.6%），低血压（33.9%），休克(20.0%)和血液动力学崩溃(8.9%)。56.9%的病例采用血管内途径治疗,19.4%采用开放手术方法，23.6%为管理杂交。结论：本综述提示内脏动脉瘤与大小可变的正中弓状韧带破裂有关。尽管无法明确关联大小和破裂风险，我们的数据支持及时干预，无论大小，鉴于不良后果。迫切需要进一步的研究来阐明大小阈值或其他预测因素以指导管理。
