The Prevalence of Comorbid Conditions in Patients With Median Arcuate Ligament Syndrome and Superior Mesenteric Artery Syndrome

Gabriela V Lozano, BS; Steve Chen, MD; Daniel Shouhed, MD

Providence Saint John’s Health Center

 

INTRODUCTION

Patients affected by Median Arcuate Ligament Syndrome (MALS) and SMA Syndrome (SMAS) are often affected by other compression syndromes¹. Diagnosis of each condition often requires a high index of suspicion. Conditions like Ehlers-Danlos syndrome (EDS)1, Postural Orthostatic Tachycardia Syndrome (POTS), and Mast Cell Activation Syndrome (MCAS) are also common in this patient population.

Patients often present with a long history of gastrointestinal (GI) complaints^2-4 and a constellation of symptoms related to dysautonomia⁵. Due to this, diagnosis of MALS and SMA Syndrome is often delayed, leading to symptom chronicity. Patients in this cohort have also been noted to have a high incidence of psychiatric conditions, adding to the complexity of this patient population6. Optimized management of associated comorbidities is essential for achieving favorable postoperative outcomes.

METHODS

• Retrospective chart review

• Patients who underwent surgery for MALS and SMAS between November 2016 and August 2025

• Data on patient demographics and past medical history were collected

• Prevalence of compression syndromes and other comorbidities were evaluated

RESULTS

• 143 patients were identified, and 42% presented with multiple compression syndromes

• 45 (32.1%) patients with MALS developed SMA Syndrome

• 39 required surgical treatment for both syndromes

• 25 out of 48 patients with a history of EDS presented with multiple compression syndromes

CONCLUSION

• Patients with MALS and/or SMAS frequently present with multiple compression syndromes.

• In this series of 143 patients, 42% were found to have an additional compression other than MALS or SMAS.

• Other comorbidities such as POTS, EDS, MCAS, anxiety, and depression are also commonly observed in this patient population.

• 31.5% of patients with MALS later developed SMAS, highlighting the interconnectivity of these syndromes

• Recognition and adequate management of these conditions by a multidisciplinary team is crucial for optimizing postoperative recovery and achieving favorable long-term outcomes.