Median Arcuate Ligament Release in Patients with POTS

Median arcuate ligament syndrome (MALS) has been described for over a century, yet the etiology and pathophysiology are not well understood. Interestingly, postural orthostatic tachycardia syndrome (POTS) has been observed to be associated with MALS, with approximately 5% of POTS patients having the diagnosis of MALS also. Based on the most current literature available, this chapter will discuss the etiology, epidemiology, clinical features, diagnostic findings, therapeutic options, and anesthetic considerations for patients with POTS and MALS. The laparoscopic approach is now widely accepted as the standard for surgical treatment. The anesthetic management of these patients must include several unique considerations in the preoperative, intraoperative, and postoperative phases.