Arcuate Ligament

In the setting of cadaveric liver transplantation it is more important to identify vascular anomalies of the celiac axis than hepatic artery variations. Indeed, celiac axis anomalies, such as atheromatous celiac-trunk stenosis or diaphragmatic arcuate ligament, could necessitate celiac axis revasculariza-... 

With the patient supine, the examiner grasps one lower extremity under the heel. With his other hand he supports the calf. The knee is allowed to move from 10 degrees of flexion to full extension (Fig. 94-4). If the knee becomes hyperextended with external rotation of the tibia and tibial varus, the test is positive. This indicates injury to the arcuate ligament, popliteus, and fibular collateral ligament. 

Visceral aneurysms are uncommon and most frequently involve the splenic artery. They may also arise from the pancreaticoduodenal branches of either the GDA or SMA and the left gastric artery (Fig. 14.3). Although an underlying cause may not he demonstrated, many of these are associated with acute or chronic pancreatitis or are secondary to atheromatous disease. Atheromatous stenosis of the coeliac axis or compression of the coeliac axis by the median arcuate ligament of the diaphragm results in hypertrophy of the pancreaticoduodenal arteries and is associated with aneurysm formation. 

Theoretically angioplasty or stent insertion could be used as treatment but the median arcuate ligament is a very strong structure and it is unlikely that... 

Fig. 14.5. Median arcuate ligament compression. Lateral abdominal aortogram showing compression of the celiac axis (arrow) by the median arcuate ligament of the diaphragm...

Ligamenta flava (arcuate, flaval, or yellow ligaments) extend from the anteroinferior border of the laminae above to the posterosuper-ior borders of the laminae below. 

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