Compressed abdominal artery leads to surgery

DEAR DR. ROACH » What is celiac artery compression syndrome? I’m told I have this, and it’s causing an aneurysm that needs to get repaired. I found out on a scan taken for another reason.

— I.J.M.

DEAR READER » The celiac artery is one of three large arteries that provide blood to the abdominal organs, especially the stomach, parts of the small intestine, liver and spleen. The artery can be compressed from the outside by a structure called the median arcuate ligament. When this happens, other blood vessels take over the job the celiac artery can’t do because of the compression, but sometimes people can get abdominal pain after eating due to low blood flow. People with symptoms due to celiac compression benefit from opening the artery, usually using a stent to keep the artery open. The celiac artery may also become blocked by atherosclerosis, cholesterol and calcium deposits within the blood vessel.

The increased blood flow in the other blood vessels can cause abnormal dilatations, called aneurysms. Unfortunately, these aneurysms can rupture, which is a catastrophic event. The risk of fixing the aneurysm is much smaller than the risk of rupture, so it’s recommended to first fix the celiac compression, and then treat the aneurysm, usually by a coil embolization. The coil causes a blood clot around and within the aneurysm that protects the weakened part of the blood vessel wall and reduces risk of rupture.

Vascular surgeons perform this surgery, usually through the blood vessels, without the need to open a person’s abdomen.

DEAR DR. ROACH » I had a prostatectomy over 10 years ago. After the surgery, I required 10 sessions of radiation treatment. My incontinence is not going away. I tried Kegel exercises, but that didn’t help. I am using pads regularly, and also using Cunningham clamps. Unfortunately, the leakage is still there. I have to change pads three or four times a day. I am 84 years old.

— Anon.

DEAR READER » Incontinence after prostate cancer surgery is common, and often improves in the year or so after surgery. Some men continue to have moderate or severe long-term symptoms. You have already tried some of the treatments Condom catheters are a good solution for some men.

One effective and reliable treatment is an artificial urinary sphincter. The AMS800 is a brand name of one of these devices, which is placed surgically. More than 90% of men report satisfaction.