Advertisement

Risk factors for celiac artery and superior mesenteric artery stenosis in preoperative lumbar and thoracolumbar spinal surgery patients

Published:November 09, 2022DOI:https://doi.org/10.1016/j.jos.2022.10.004

      Abstract

      Background

      Ischemic necrosis of the abdominal organs caused by compression of the celiac artery (CA) and superior mesenteric artery (SMA) by the median arcuate ligament (MAL) after correction surgery has been recognized as acute celiac artery compression syndrome (ACACS). Here, using contrast-enhanced computed tomographic (CT) images, we sought to determine the prevalence and degree of CA and SMA stenosis in spinal patients preoperatively, and the risk factors associated with the stenosis.

      Methods

      We retrospectively examined contrast-enhanced abdominal CT of 90 patients with preoperative lumbar degenerative disease, lumbar burst fracture, or adult spinal deformity. The trunks of the CA and SMA were detected using three-dimensional reconstructed CT. To investigate their degree of stenosis, we determined the ratio of the narrowest diameter of the stenotic segment to the distal normal lumen's diameter. Patients with a degree of stenosis ≥35% were defined as being in the group with stenosis and the remainder as in the group without. To determine the risk factors for stenosis of these arteries, the relationship between the stenosis and CA and SMA calcification or the median arcuate ligament (MAL) crossing the proximal portion of the celiac axis (MAL overlap) was also investigated.

      Results

      The average degree of stenosis of the CA trunk was 12.1% ± 13.9% and that for the SMA trunk was 8.5% ± 8.8%. There were 8 patients (8.9%) in the group with CA stenosis and 2 patients (2.2%) in the group with SMA stenosis. The number of patients in the group with CA stenosis was significantly greater than the number with MAL overlap or CA calcification (P < 0.05).

      Discussion

      The prevalence of CA or SMA stenosis was 11.2% of preoperative patients due to undergo thoracolumbar fusion surgery. Calcifications of the CA trunk and MAL overlap are risk factors for CA stenosis.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kotani T.
        • Sakuma T.
        • Iijima Y.
        • Sato S.
        • Nakanishi K.
        • Ueda T.
        • et al.
        Acute celiac artery compression syndrome with superior mesenteric artery stenosis and aortic stenosis: a rare but life-threatening complication after adult spinal deformity surgery.
        J Orthop Sci. 2020 Aug 17; (S0949-2658(20)30202-5. Online ahead of print)
        • Notani N.
        • Miyazaki M.
        • Yoshiiwa T.
        • Ishihara T.
        • Tsumura H.
        Acute celiac artery compression syndrome after extensive correction of sagittal balance on an adult spinal deformity.
        Eur Spine J. 2017 May 23; 26: S31-S35
        • Daniels A.H.
        • Jurgensmeier D.
        • McKee J.
        • Harrison M.W.
        • D'Amato C.R.
        Acute celiac artery compression syndrome after surgical correction of scheuermann kyphosis.
        Spine. 2009 Feb; 34: 149-152
        • van Urk P.R.
        • Littooij A.S.
        • van Gestel JPJ
        • Kruyt M.C.
        Celiac artery syndrome after correction of Kyphoscoliosis.
        Spine Deform. 2019 Jan 1; 7: 176-179
        • Debnath U.K.
        • Sharma H.
        • Roberts D.
        • Kumar N.
        • Ahuja S.
        Coeliac axis thrombosis after surgical correction of spinal deformity in type VI Ehlers-Danlos syndrome: a case report and review of the literature.
        Spine. 2007 Aug; 32: 528-531
        • Von Glinski K.S.
        • Krettek C.
        • Blauth M.
        • Oldhafer K.J.
        Hepatic ischemia as a complication after correction of post-traumatic gibbus at the thoracolumbar junction.
        Spine. 2000 Apr; 25: 1040-1044
        • Vasiliadis H.S.
        • Teuscher R.
        • Kleinschmidt M.
        • Marrè S.
        • Heini P.
        Temporary liver and stomach necrosis after lateral approach for interbody fusion and deformity correction of lumbar spine: report of two cases and review of the literature.
        Eur Spine J. 2016 May 1; 25: 257-266
        • Sugae T.
        • Fujii T.
        • Kodera Y.
        • Kanzaki A.
        • Yamamura K.
        • Yamada S.
        • et al.
        Classification of the celiac axis stenosis owing to median arcuate ligament compression, based on severity of the stenosis with subsequent proposals for management during pancreatoduodenectomy.
        Surgery. 2012 Apr; 151: 543-549
        • Soman S.
        • Sudhakar S.V.
        • Keshava S.N.
        Celiac axis compression by median arcuate ligament on computed tomography among asymptomatic persons.
        Indian J Gastroenterol. 2010 Jun; 29: 121-123
        • Criqui M.H.
        • Denenberg J.O.
        • Ix J.H.
        • McClelland R.L.
        • Wassel C.L.
        • Rifkin D.E.
        • et al.
        Calcium density of coronary artery plaque and risk of incident cardiovascular events.
        JAMA. 2014 Jan; 311: 271-278
        • Samuels O.B.
        • Joseph G.J.
        • Lynn M.J.
        • Smith H.A.
        • Chimowitz M.I.
        A standardized method for measuring intracranial arterial stenosis.
        AJNR Am J Neuroradiol. 2000 Apr; 21: 643-646
        • Baskan O.
        • Kaya E.
        • Gungoren F.Z.
        • Erol C.
        Compression of the celiac artery by the median arcuate ligament: multidetector computed tomography findings and characteristics.
        Can Assoc Radiol J. 2015 Aug; 66: 272-276
        • Dyches R.P.
        • Eaton K.J.
        • Smith H.F.
        The roles of celiac trunk angle and vertebral origin in median arcuate ligament syndrome.
        Diagnostics. 2020 Jan 31; 10: 76
        • Unnikrishnan R.
        • Anjana R.M.
        • Mohan V.
        • Velmurugan G.
        • Dinakaran V.
        • Rajendhran J.
        • et al.
        New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: a 25-year follow-up study.
        Atherosclerosis. 1997 Jul; 132: 245-250
        • Ayça B.
        • Rakıcı T.
        • Atıcı Y.
        • Avsar M.
        • Yuksel Y.
        • Akın F.
        • et al.
        Adult degenerative scoliosis associated with increased aortic diameter and plaque burden and composition.
        Vascular. 2016 Jun; 24: 315-322
        • Wilson D.B.
        • Mostafavi K.
        • Craven T.E.
        • Ayerdi J.
        • Edwards M.S.
        • Hansen K.J.
        Clinical course of mesenteric artery stenosis in elderly Americans.
        Arch Intern Med. 2006 Oct; 166: 2095-2100
        • Cademartiri F.
        • Raaijmakers R.H.J.M.
        • Kuiper J.W.
        • Van Dijk L.C.
        • Pattynama P.M.T.
        • Krestin G.P.
        Multi-detector row CT angiography in patients with abdominal angina.
        Radiographics. 2004 Jul-Aug; 24: 969-984
        • Rocha-Singh K.J.
        • Zeller T.
        • Jaff M.R.
        Peripheral arterial calcification: prevalence, mechanism, detection, and clinical implications.
        Cathet Cardiovasc Interv. 2014 May 1; 83: E212-E220
      1. Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res. 66:6–9.