Evaluation of Abdominopelvic Vascular Compression Syndromes using Computed Tomography

Abstract

Introduction: Various abdominopelvic vascular compression syndromes can cause a wide spectrum of symptoms which can be diagnosed incidentally in asymptomatic patients or in patients in which imaging was done for other indications. The purpose of this study is to evaluate the typical imaging findings of superior mesenteric artery syndrome, median arcuate ligament syndrome, nutcracker syndrome, and May-Thurner syndrome using computed tomography and correlating with clinical symptoms. Methods: This observational, cross-sectional study was performed on patients who were referred for computed tomography of the abdomen and pelvis for various indications. Different measurements, ratios, and common symptoms for superior mesenteric artery syndrome, median arcuate ligament syndrome, nutcracker syndrome, and May-Thurner syndrome are discussed separately under each heading. Result: A total of 35 patients were included in this study with 10 patients each with superior mesenteric artery syndrome, median arcuate ligament syndrome, and nutcracker syndrome with five patients of May-Thurner syndrome. Out of 35, 24(68.5%) were female and 11(31.5%) were male. SMAS: The mean age of individuals was 32.7 ± 17.5 years with a mean aortomesenteric angle of 18.3º and aortomesenteric distance of 6.2 mm. MALS: The mean age of patients was 34.3± 15.8 years and the mean thickness of the median arcuate ligament was 5.4 mm. NCS: The mean age of patients was 37 ± 22 years and the mean compression ratio was 3.9. MTS: Mean age was 45± 14.2 years with mean diameter of LCIV 2.4 mm. Conclusion: Abdominopelvic compression syndromes are rare and often underdiagnosed because of a lack of awareness among clinicians and radiologists. Contrast-enhanced triple-phase computed tomography is performed to maximize the visibility of involved vessels in different planes and allow the identification of typical imaging features and possible complications.