evaluation of vascular entrapment and extrinsic compression

vascular entrapment syndromes

rare, often undiagnosed conditions where blood vessels are compressed by surrounding muscles, ligaments, or bones, restricting blood flow and causing pain, swelling, and ischemic symptoms

May-Thurner syndrome

compression of the left common iliac vein by the right common iliac artery, leading to pelvic congestion and thrombosis (DVT)

nutcracker syndrome (left renal vein entrapment)

the left renal vein is compressed between the abdominal aorta and the SMA, causing hematuria and flank pain

medial arcuate ligament syndrome (MALS)

the diaphragm’s median arcuate ligament compresses the celiac artery, causing chronic abdominal pain, nausea, and weight loss

popliteal artery entrapment syndrome (PAES)

the main artery behind the knee is compressed by muscles, common in athletes, causing calf pain, numbness, and claudication

superior mesenteric artery syndrome

the third part of the duodenum is compressed by the aorta and SMA, causing upper abdominal pain and vomiting

thoracic outlet syndrome (TOS)

compression of neurovascular structures in the neck/shoulder area

symptoms of vascular entrapment syndromes:

• vary based on the vessel

• chronic pain (abdominal, pelvic, limb)

• swelling

• blood clots

• ischemia

• nausea

• vomiting

• dizziness

• coldness in the limbs

• calf cramping during exercise

how are vascular entrapment syndromes diagnosed?

requires high clinical suspicion and imaging, such as Doppler ultrasound, CT angio, or MR angio

treatment for vascular entrapment syndromes:

focuses on relieving the compression

surgical treatment for vascular entrapment syndromes:

• surgical release of ligaments

• bypass grafting

• vascular reconstruction

endovascular treatment for vascular entrapment syndromes:

stenting or ballooning angioplasty to open compressed veins

compartment syndrome

occurs when pressure builds up inside muscle compartments, restricting blood flow and oxygen delivery

what areas does compartment syndrome commonly affect?

• legs

• arms

• feet

• abdomen

• buttocks

what happens if compartment syndrome is left untreated?

can cause permanent muscle damage, paralysis, or death

anatomy of a compartment:

a compartment includes muscles, nerves, and blood vessels all enclosed by fascia

acute compartment syndrome

occurs suddenly from severe injuries and requires immediate medical treatment to present tissue damage

chronic compartment syndrome

develops gradually from repetitive activities causing pain and limiting physical performance