Kurtis Kim
Current Position
International Foundation of Abdominal Vascular Compression Syndromes
Short Topics Session

Topic: Abdominal Vascular Compression Syndromes (AVCS): Current and Future of Management of AVCS that includes Median Arcuate Ligament, Nutcracker, Superior Mesenteric Artery, May-Thurner, and associated Pelvic Venous Insufficiency


OBJECTIVE: There has been increasing awareness of the vascular compression syndromes especially the Iliac Venous Compression Syndrome, but not enough understanding of the interconnectivity of, and co-existing vascular compression syndromes such as Median Arcuate Ligament, Nutcracker, Superior Mesenteric Artery Syndromes with pelvic venous congestion involvement especially in patients who has Ehlers-Danlos Syndrome (EDS).
METHOD: 250+ patients in USA, Asia, Europe, and Middle East presenting with multiple compression syndromes were consulted. The data based on presenting symptoms, image findings, surgeries, and the outcomes from various corrective surgeries for several vascular compression syndromes were analyzed.
RESULT: Time from onset of symptoms to diagnosis and treatment ranged from 1 month to 40+ years. Average number of physicians seen for their diagnosis is 14 (range 4-51). Majority of patients in this group travel out of state or country to receive seek care. More than 90% of the patients presenting with multiple vascular compression syndromes were evaluated and treated for only one vascular compression syndrome with suboptimal to poor outcome. Surgical correction of one compression syndrome in the presence of other vascular compression syndromes seems to worsen the symptoms of untreated compression syndromes. Correction of other vascular compression syndromes improved or resolved their symptoms. There was a strong correlation with EDS with patients presenting with 3 or more vascular compression syndrome. These patients also had high rate of Mast Cell Activation Syndrome (MCAS). CONCLUSION: Our experience suggests that in appropriate patients especially in EDS patients, thorough evaluation of all vascular compression syndromes that exist in the abdomen - Abdominal Vascular Compression Syndrome (AVCS) - is a reasonable approach to improve their outcome, lessen the number of interventions and surgeries, and minimize the time from onset of symptoms to diagnosis and/or treatment. Understanding of multisystemic symptoms of AVCS and overlapping symptoms (Figure 1) is of great value in assisting physicians and patients. Correlation of EDS and AVCS need further research with multidisciplinary team.