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Median Arcuate Ligament Syndrome

Understanding Median Arcuate Ligament Syndrome

At CardioVascular Health Clinic, your heart health is our top priority. 

If you or a loved one has been diagnosed with MALS disease or is experiencing symptoms consistent with this condition, it is vital to get evaluated and understand your options for effective and timely treatment. 

Median arcuate ligament symptom is a rare disease that often goes undiagnosed for years due to its effect on the digestive system rather than the cardiovascular one. 

While considered rare, the experienced vascular specialists at CardioVascular Health Clinic care for patients with MALS disease weekly, providing comprehensive diagnosis and personalized treatment plans.

Let’s discuss median arcuate ligament syndrome in more detail, including what it is, common symptoms, and effective treatment options necessary to take care of the disease and prevent the progression of symptoms. 

What Is Median Arcuate Ligament Syndrome?

MALS disease, or median arcuate ligament syndrome, is a congenital anatomic anomaly often present at birth. In some instances, it may also present after abdominal surgery or trauma.

Although present at birth, there are no known ties to genetics. Therefore, the root cause of MALS syndrome is still widely unknown.

What Causes MALS Disease?

Median arcuate ligament syndrome occurs when the arc-shaped band of tissue in the chest area (median arcuate ligament) presses on the artery that sends blood to the upper abdomen. This artery is called the celiac artery. 

When this occurs, it gives rise to three important arteries in the spleen, stomach, and liver and impairs adequate blood flow to the liver, stomach, and other organs.

Symptoms of Median Arcuate Ligament Syndrome

Although MALS syndrome is present at birth, symptoms typically don’t manifest until puberty.

The most common symptom of MALS disease is abdominal pain above the bellybutton that can be as painful as and similar to appendicitis, which often worsens after eating.

Other symptoms include

  • Indigestion
  • Nausea
  • Constipation 
  • Diarrhea
  • Unintentional weight loss
  • Irritable bowel syndrome
  • Abnormal sound in the abdomen (abdominal bruit - whooshing sound)
  • Exercise-induced epigastric (upper-middle abdomen) pain
  • Irregular blood pressure

MALS Disease Diagnosis 

Because of its rarity, MALS disease is not widely understood, taught, or published about in medical journals. Its rare nature makes it difficult to pinpoint and diagnose, so working with a vascular specialist is essential to understand this cardiovascular condition.

Most patients have extensive GI workups due to the disease's abdominal symptoms. Testing may include

  • Checking the upper and lower GI and gall bladder
  • Conducting a gastric emptying study
  • Providing a full GI workup with a scope 

If no GI issues are noted, doctors often follow a process of elimination approach to exclude other conditions.

At CardioVascular Health Clinic, our team of vascular specialists may perform any of the following to verify and confirm a MALS disease diagnosis:

  • CT scan
  • Mesenteric angiogram procedure - with and without expiration 
  • Mesenteric Duplex 

Median Arcuate Ligament Syndrome Treatment

The only effective treatment for MALS disease is surgery. Without treatment, disease progression may worsen.

The most common treatment option is median arcuate ligament release or decompression. This open surgery splits the median arcuate ligament and network of nerves in the stomach. 

This surgery

  • allows more room for the artery
  • restores blood flow
  • relieves pressure on the nerves

Sometimes, patients may also need revascularization surgery to repair or replace a blocked celiac artery.

It is important to understand that MALS disease treatment often involves an all-hands-on-deck approach from a group of doctors to effectively care for the patient in all aspects of their health and healing journey. 

Physicians can include those that specialize in

  • blood vessels (vascular specialists/surgeons)
  • cardiovascular system (cardiologists)
  • digestive system (gastroenterologists)
  • nervous system (neurologists)

We support a patient’s primary care doctor and other specialists in diagnosing and treating this condition at all stages of the disease and care plan. 

Effective Care for Median Arcuate Ligament Syndrome in Oklahoma

The experienced team at CardioVascular Health Clinic specializes in treating cardiovascular conditions like MALS disease. We proudly remain at the forefront of innovative technology to deliver the highest quality of care. 

Don’t wait another day to take charge of your heart health; call CardioVascular Health Clinic today at (405) 701-9880 or contact us to schedule an appointment.

Patient Resources

We’re committed to timely, efficient, and affordable care.
Here is a collection of useful resources our new and existing patients need in one convenient location.
Please let us know if you need additional information or have any questions.


I’m about one month out and things are so much better. At my two week evaluation my symptom score had gone from a 27 to a 7, and I’m sure it’s even better now. That speaks volumes. Now that I’m post recovery, there is no incontinence, I go to the bathroom much less and there are no ED side effects like there are with other procedures. In regard to my quality of life, well, I don’t maintain my life based on my proximity to a bathroom anymore.

Blaine P., M.D.
Professional staff working in a beautiful facility with great doctors who sincerely care about their patients. Without Dr. Schmidt's skill, I would have needed heart bypass surgery instead of a stent. Follow-up has been thorough. I can't recommend them highly enough.
LeAnn H.

Dr. Jim Melton and all the staff are fantastic. He is an excellent surgeon and his team is GREAT!!!! I just had surgery at the surgery center, I have only great things to say about my experience. Without him I really don't think I would be here to write this. If you’re looking for a good cardiovascular team, they are a 5 star for sure.

Susie H.

Dr. Parsons and staff are amazing. He truly listened to me from the consult. Staff showed genuine care for my progress post procedure. I had my follow up appointment today so satisfied with results. Blake made me comfortable from the start. He is an activist for uterine fibroids treatment beyond the standard.

Tamara M.

Professional and caring staff. Dr. Smith is very knowledgeable and shows genuine concern for your personal health. I enjoyed the background music in the procedure room, it really adds to the relaxing atmosphere.

David L.

Dr. John Schrader is the most personable doctor we know. He stays on top of my dads health care and is genuinely concerned about his health. We never leave his office with questions. He answers them all. Even questions we don’t think of. Always professional but never cold or bad bedside manner. In our opinion he is THE BEST around.
Thank you Dr Schrader.

Kathy J.

I came to Dr. Warren by a self referral for mals when it took me 8yrs 50+ doctors and thousands of dollars spent on no answers. My first visit I was scared I was just going to be gaslighted just like the past however I was pleasantly shocked when Dr. Warren immediately believed me. She took the time to review many disk I had brought from past tests. She never once dismissed me and listened to ever word I had to say. She scheduled one last test to confirm the diagnosis then I was scheduled for surgery right away. Surgery was a success and I can’t thank her and her staff enough. Dr. Warren truly saved my life.

Angie W.

Dr. Garner literally saved my life 18 months ago and I've followed him to his new practice with Cardiovascular Health. He explains things so clearly, listens and is just a very nice person. His staff is great, too! I highly recommend!

D Watts

Some of the nicest staff that I have ever dealt with!! They have been so incredibly awesome to my mom!! Would definitely recommend them to anyone!! Thank you so much for being so great with her!!

Christy G.

The staff, the nurses, and Dr. Parsons were all amazing. Everything was simple and went well – very Bravo Zulu (military phrase meaning "well done"). In addition to the great staff at CardioVascular Health Clinic, the facilities were clean and well maintained. I have no complaints about anything. The whole experience was A1. I would recommend Dr. Parsons to anyone. He made a huge impact on my life.

John W.

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