The celiac axis compression syndrome (CACS) due to median
arcuate ligament (MAL) was first described by Harjola in 1963;
originating postpandrial abdominal pain, weight loss, epigastric
bruit and celiac axis stenosis > 75% in angiographic studies. This
clinical condition has been the origin of controversies about its
pathogenesis, diagnosis and its long term clinical results.
Advances in diagnostic imaging as 64 multidetector–row CT
(MDCT), 3-D reconstruction, magnetic resonance (MR) and color
duplex ultrasonography, provide better understanding of the syndrome
and allow to identify the best candidates for surgical division
of MAL fibers.
Since the introduction of laparoscopic approach, and also endovascular
procedures, in 2000, a new perspective has established
in this challenging syndrome. With the occasion of our own
experience, a critical review of the syndrome is presented
