Between a Rock and a Hard Place: Clinical and Imaging Features of Vascular Compression Syndromes

Abstract

Vascular compression syndromes are caused by the entrapment of vessels between rigid or semirigid surfaces in a confined anatomic space. Chronic entrapment may lead to arterial ischemia and embolism, venous stasis and thrombosis, and hematuria. These syndromes are usually seen in otherwise healthy young patients, among whom underdiagnosis is common. Most occurrences of vascular compression are associated with an underlying anatomic abnormality. In a small percentage of cases, other contributing factors, including repetitive microtrauma, may cause pathologic changes leading to the onset of pain and other symptoms of vascular and neural compression. Hence, the diagnosis must be based on both clinical and radiologic findings. Because some cases of vascular entrapment become symptomatic only when specific physical maneuvers are performed, dynamic diagnostic imaging methods are especially useful. Digital subtraction angiography has been the mainstay of imaging-based diagnosis for most vascular compression syndromes, but other methods (eg, color Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography) are used with increasing frequency for initial diagnostic evaluation. Because vascular compression syndromes are caused by the external compression of vessels, endoluminal treatment alone is rarely adequate and surgical decompression is likely to be required for optimal and durable clinical benefit. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.321115011/-/DC1.

Venous compression syndromes: clinical features, imaging findings and management

“…Extrinsic venous compression occurs by adjacent arterial, ligamentous, muscular or osseous structures in tight anatomic spaces [1]. Despite its relative infrequency, venous compression is most commonly seen in otherwise healthy and young individuals and may cause significant haemodynamic alterations that may lead to clinical symptoms and significant associated morbidity.…”

“…A wide range of signs and symptoms may be seen, including pain, swelling, venous thrombosis, varicosities and haematuria [1,2]. External venous compression incidentally demonstrated by imaging may not be of clinical significance on its own; therefore, imaging should be used for confirmation of the cause of the symptoms.…”

Minimally invasive treatments for venous compression syndromes

“…While this phenomenon can be seen incidentally in asymptomatic patients, there are several known syndromes that can lead to significant morbidity if left untreated. These syndromes are relatively uncommon (less than 1% of the general population), and are most commonly seen in young and otherwise healthy individuals (1).…”

“…Suspected venous compression syndrome can be evaluated with several noninvasive imaging modalities including ultrasonography, computed tomography (CT) with venography (CTV), and magnetic resonance imaging (MRI) with venography (MRV) (1). The gold standard in diagnosis is digital subtraction venography (DSV) with multiple projections and obliquities (1).…”

“…Endovascular treatment options offer a minimally invasive approach to select cases, with several reports of long-term efficacy demonstrated in the literature (1).…”