Learn More About Vascular Compression Syndromes

MALS — Median Arcuate Ligament Syndrome

SMAS — Superior Mesenteric Artery Syndrome

NCS — Nutcracker Syndrome

PCS — Pelvic Congestion Syndrome

TOS — Thoracic Outlet Syndrome

MTS — May-Thurner Syndrome

  • There are many different types of Vascular Compression Syndromes that cause many different symptoms effecting the renal system, gastrointestinal system, and more.

    Some are known as:

    • MALS — affects GI system

      • When the median arcuate ligament sits lower than normal causing pressure on main blood vessels that supply blood flow to the stomach and liver

    • SMAS — affects GI system (specifically duodenum)

      • When the duodenum (connects stomach to small intestines) gets pinched by two arteries causing a narrowing of the duodenum limiting food intake

    • NCS — affects GI system and Renal system

      • When arteries pinch the left renal vein (carries blood from kidney back to the heart) causing pain

    • TOS — affects blood vessels and nerves (pain in upper ribcage and collarbone region)

      • When blood vessels and nerves better the collarbone and ribs become compressed causing pain

    • MTS — occurs near pelvis

      • compression of the left iliac vein

    Vascular compressions cause different symptoms depending on where they are throughout the body, but they occur due to excess pressure put on blood vessels limiting blood flow.

    Vascular compressions effect roughly 0.002% of the population making them very hard to diagnose and treat due to limited research. Vascular compressions typically affect younger females over males.

    Due to limited research, why vascular compressions develop is still not well understood. However, some research highlights a connection between Elhers-Danlos Syndromes (EDS) and some vascular compressions.

  • Symptoms of Vascular Compressions can differ from person to person and can differ from condition.

    Some common symptoms are:

    • MALS

      • Pain in the upper middle stomach area (typically after eating, exercising, or changing body position)

      • Bloating

      • Diarrhea

      • Weight loss

      • Nausea and vomiting

    • SMAS

      • nausea

      • vomiting

      • abdominal pain

      • indigestion

      • early satiety

      • weight loss

    • NCS

      • flank pain

      • stomach pain

      • blood in urine

      • pelvic congestion

      • back pain

      • headache

      • bloating

      • leg swelling

    • TOS

      • neck, shoulder, and arm pain

      • numbness in arm, hand, and fingers

      • poor circulation

      • weakness

      • swelling

    • MTS

      • leg pain

      • deep vein thrombosis

      • leg swelling

      • pelvic pain

      • varicose veins in legs

  • Diagnosing compressions can be difficult and for many of them specific protocol must be taken.

    Some tests used to diagnose compressions include:

    • MALS

      • Angiogram

      • Doppler ultrasound

      • CT scan

      • MRI scan

    • SMAS

      • Angiogram

      • Doppler ultrasound

      • CT scan

      • MRI scan

    • NCS

      • Doppler ultrasound

      • CT scan

      • MRI scan

      • Venogram

    • PCS

      • Pelvic venography

      • MRI scan

      • Pelvic ultrasound

    • TOS

      • Ultrasounds

      • X-ray

      • CT scan

      • MRI scan

      • Arteriography and venography

      • Electromyography (EMG)

    • MTS

      • Doppler ultrasound

      • CT scan

      • MRI scan

  • Each compression has different treatments, however, due to limited research there is not a lot of options.

    Some treatment options consist of:

    • MALS

      • median arcuate ligament release surgery

    • SMAS

      • fluid resuscitation

      • electrolyte correction

      • total parenteral nutrition

      • feeding tube (NJ or J-tube) that bypasses the compression

      • surgery to release the compression

    • NCS

      • stenting

      • surgery

      • routine urinalysis

    • PCS

      • medications targeted towards hormones

      • surgery (hysterectomy)

    • TOS

      • physical therapy

      • botulinum toxin injections

      • surgery (scalenectomy)

    • MTS

      • blood thinners

      • thrombolysis

      • stenting

      • compression stockings