About

These abdominal vascular compressions can afflict individuals of all ages and sexes, but they most frequently affect young (and particularly thin) females in their 20s to 40s. However, patients can start developing symptoms at earlier ages. With Nutcracker Syndrome, some studies have posed that an approximately equal proportion of females and males are affected, with a large portion of pediatric patients. Regardless, these conditions are highly under-studied, under-recognized, and under-diagnosed among patient populations at the time of writing.

Certain barriers to diagnosis and care persist, complicating the diagnostic process for many patients suffering with these syndromes. The first, as alluded to, is the lack of awareness among medical providers (with reference but not limited to the US medical system). The treatment of these syndromes is generally not taught to healthcare professionals in a standard academic curriculum. Even many vascular surgeons, who are among the primary specialists treating these conditions, are unaware of these conditions and/or do not treat them. Because a vascular specialist tends to not be the first medical provider a patient will see, anyway, many patients will see a long line of primary care physicians, internists, gastroenterologists, gynecologists, urologists, and more.

As symptoms can involve pressure, heaviness, and pain in the abdomen and pelvis that are felt in multiple regions due to the physiology of the conditions, it may be difficult for both patients and providers to pinpoint the sources of pain. Symptoms may be attributed to more commonly diagnosed conditions such as Irritable Bowel Syndrome (IBS), Gastritis, or Endometriosis for females specifically. While vascular compression patients may, in fact, have one or more of these conditions as well, the failure to diagnose the vascular compressions can lead patients to be undertreated, mistreated, or even undergo unnecessary surgeries.

As a further challenge, these conditions are often difficult to diagnose through imaging. Patients may have an ultrasound, CT, and/or MRI and told that nothing is wrong. Vascular and surrounding structures may appear normal and it can be difficult to discern abnormalities like vein compressions. This can especially be the case if physicians interpreting the imaging do not focus on the relevant anatomy. Regardless, scans like these alone may not be sufficient to make a diagnosis. The diagnostic tests utilized and symptom summaries are described in “The Syndromes” tab, the section outlining each syndrome.

Because of these numerous roadblocks associated with AVCS, more awareness is needed among medical providers and the general population. If more medical providers understood these conditions, patients would not have to run through as many hoops, and go years, even decades without a diagnosis. A greater awareness among the general population could enable more patients to recognize symptoms they suspect they have and be able to pursue appropriate treatment sooner. Hopefully, this online resource will be of some help and elucidate questions about treatments of AVCS – and what their names are!

Associated Symptoms

If a blood vessel is compressed somewhere, then that keeps blood from flowing through properly. As a result, blood will pool backwards, causing vein dilation. Dilated veins can leak into surrounding tissues. This can make it even more difficult to pinpoint the source of pain due to, for example, a potential widespread fullness feeling throughout the abdomen, with abdominal distention and bloating. Some patients may experience what feels like a fluid buildup or edema. Some may feel they’re experiencing a “dripping” or draining sensation, as if there is fluid moving in the abdomen accompanied by feelings of heaviness. This sensation and the pooling of blood is part of venous reflux. Collateral veins – smaller veins which could form in order to provide alternate pathways for blood to flow – may also form around the area of the compressed vein, causing further pain.

If blood is not flowing properly and is pooling, this area may be warm to touch on the skin. The location/s where this is experienced are helpful in determining where there is vein dilation. Along with abdominal pain, some may experience sensations of pelvic pain, pressure, and fullness – particularly with May-Thurner Syndrome and Nutcracker Syndrome. The pressure from the compression, vein dilation, and pooling of blood can result in pelvic floor tension. Symptoms of pelvic burning can also occur, due to pelvic tightness and even from pelvic veins pressing on a nerve, such as the pudendal nerve.

Another potential symptom is constipation. Pelvic congestion syndrome, which is further discussed, is known to co-occur with May-Thurner and Nutcracker. This is generally associated with ovarian vein dilation, which can trigger glute heaviness. Straining from constipation is a trigger for hemorrhoids. Additionally, urinary retention is another troubling symptom. The dilation of veins in the lower abdomen and pelvis puts pressure on the bladder and pelvic floor, making it difficult to completely empty and even leading to sensations of incomplete urination.

Fatigue can commonly occur due to improper blood flow in major vessels. Arterial compression in MALS, cutting off blood supply to the stomach and liver, is a trigger of pain. In Superior Mesenteric Artery Syndrome, part of the small intestines gets compressed by two arteries. In both conditions, gastrointestinal pain, nausea, and vomiting can result.

Because there are many potential causes of abdominal pain, patients may get misdiagnosed with GI issues instead of vascular compressions (and some may have GI symptoms resulting from compressions). This is why it is vital for medical providers to be diligent and thorough in evaluating the types of pain experienced, the location, other symptoms, and movements that relieve or exacerbate symptoms.