Someone with pain in their stomach

Median Arcuate Ligament Syndrome (MALS) is a type of vascular compression that occurs when a ligament in the lower part of your chest (median arcuate) sits lower than normal and presses against the main blood vessel that supplies blood to the stomach, liver and other organs. It can also press against nerves around the artery.

This slows the flow of blood to those organs and can cause pain in the top part of your belly.

MALS has symptoms similar to appendicitis, stomach aches, IBS and other stomach issues. Some people may even be told the pain is "in their head." This can make its diagnosis a long process, and people can sometimes go for years without a proper diagnosis, which can lead to mental anguish.

At the UM Heart and Vascular Center, we take your concern and pain seriously. Our vascular surgery team has access to the latest diagnostic technologies, which help us to accurately diagnose MALS and develop a treatment plan.

To make an appointment with our team or to learn more about our program, call 410-328-5840.


People with MALS sometimes have no symptoms. When symptoms are present, they may include:

  • Pain in the upper belly, especially after eating or exercise
  • Nausea
  • Diarrhea

Women ages 20-40 are most likely to experience MALS. Symptoms are usually most severe after rapid weight loss.


Our imaging specialists have access to the latest in diagnostic technology, allowing us to see what's happening inside your body without have to make an incision.

Diagnostic equipment we may use includes:

  • Angiogram: this is an outpatient procedure done in our office that allows us to see inside your blood vessels
  • Doppler ultrasound: this allows us to see your blood flow in real time
  • CT scan: we take x-ray images from several different angles to build a 3D picture of what is happening inside your body
  • MRI: this allows us to create detailed images of your veins


A minimally invasive procedure for MALS can provide immediate relief. Minimally invasive procedure means a smaller incision and a shorter hospital stay.

During the procedure, we will use a catheter to access the median arcuate ligament, make a few tiny incisions on the ligament and insert an object to relieve pressure on the blood vessel.

Some patients may require open surgery to achieve the best results. Our team will discuss all options with you to find the best approach.

Make an Appointment

We want to hear from you if you are experiencing MALS symptoms. To make an appointment or to learn more about our program, call 410-328-5840.