This study aims to identify potential risk factors for becoming symptomatic in patients with radiographic celiac artery compression (CAC) as well as prognostic factors for patients with median arcuate ligament syndrome (MALS) who underwent surgical ligament release.This is a retrospective cohort study of patients with findings of CAC on computerized tomography or magnetic resonance angiography (CT/MRA) who were asymptomatic and who were diagnosed with MALS at a single university hospital between January 2001 and January 2018.Following a review of 1,330 CT/MRA reports, a total of 109 patients were identified as having radiographically apparent CAC. Among these, 48 (44.0%) patients were symptomatic. Univariate comparison between those with and without symptoms showed that symptomatic patients were more commonly younger than 30 years old [17/48 (35.4%) vs. 8/61 (13.1%); p = 0.006], had history of prior abdominal surgery [25/48 (52.1%) vs. 18/61 (29.5%); p = 0.017] and high-grade stenosis [32/43 (74.4%) vs. 25/61 (41.0%); p = 0.001]. Among 41 included patients that underwent surgical release of the median arcuate ligament including open, laparoscopic, and robotic approaches, 82.9% reported overall clinical improvement, 5/41 (12.2%) reported persistent pain, and 13/36 (36.0%) experienced pain recurrence. The only identified risk factor associated with symptom recurrence was ASA class III [7/13 (53.8%) vs. 4/23 (17.4%); p = 0.029].The severity of stenosis and prior abdominal surgery both contributed to symptom development in patients with radiographically apparent celiac artery compression from the median arcuate ligament.