syndrome pathophysiology diagnosis and treatment of abdominal vascular compression syndromes T Scholbach 1 W Sandmann 1 2 1 Functional Ultrasound Practice Leipzig Germany ID: 1031967
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1. The lordogenetic midline syndrome - pathophysiology, diagnosis and treatment of abdominal vascular compression syndromesT. Scholbach1, W. Sandmann1, 21. Functional Ultrasound Practice, Leipzig, Germany2. Clinic Bel Etage, Vascular Surgery, Düsseldorf, GermanyTalk presented at the Annual Meeting of the German Angiological Society 21.09.-23.09.2023 in Leipzig, Germany
2. DisclosureThomas Scholbach and his son Jakob Scholbach have developed the PixelFlux-software
3. 33 years observation – thousands of patientsHigh prevalence in undiagnosed „psychosomatic“ pain patientsFemale – hyperflexible – tall Potpourri of symptomsThoracic - epigastric – left flank – deep pelvic - leg painSwelling (lower abdomen – legs)Vegetative symptoms: nausea, vomiting, postural tachcardia, faintingNeuro- symptoms: numbness, weakness, paralysis, bladder and bowel issuesMultiple compressions occur togetherYou cannot properly evaluate them without functional testingGravitation – Digestion – Micturation – Blood flow quantificationPIXELFLUX - European Ultrasound Award 2015
4. All abdominal compression syndromes areconsequences of a strong lumbar lordosisNutcracker syndromeCeliac artery compression syndrome May-Thurner-syndromeSuperior mesenteric artery syndrome Compression of the inferior vena cavaPelvic congestion syndromeMidline congestion syndromeLumbar artery compression Compression of the femoral veins 12345689
5. Nutcracker syndrome –stretched hips
6. Nutcracker syndrome –flexed hipsHip flexion induces kyphosis – flow velocity drops dramaticallyfrom 346 to 50 cm/s, left renal vein compression disappearsNo turbulences anymore
7. Compression of the inferior vena cava20 cm/s170 cm/sActive flexion of the lumbar spine
8. Distal to entire cortex ratio 0,17 0,47 0,68 Left renal perfusion (shown below [cm/s/cm²]) is directly dependent on the degree of lumbar lordosis: less lordosis– less venous pressure – better small vessel perfusion- higher overall perfusion Lordosis = venous pressure = small vessel hypoperfusion
9. Superior mesenteric artery syndrome 11 mm6 mmLordosis: supine position, strechted hipsKyphosis : left side position, flexed hipsVena cavaVena cavaspinespine
10. 134 operated patients with abdominal compression syndromes 7/2019 - 08/ 2023
11. PTFE wrapping and MALS resectionExternal PTFE –wrappingof the left renal vein and the left common iliac veinMALS resection
12. Treatment resultsSuccessful decompression - n = 129Recurrent compression - n =2Residual compression - n =2Remaining compression - n =1No death, no infection, no thrombosis3 reconstructions – extensionsNo removals
13. Long term treatment results of 196 adult and 58 pediatric cases 2005 - 202090.5% of SMAS-patients pain-free eating and weight gain within 6 months post SMA – TX98 % amenorrhea resolved in 2 years95 % adult MALS-patients significantly improved within 3 m93 % (54/58) pediatric MALS patients - symptom free 62 m postop
14. Important practical consequencesAbdominal vascular compression syndromes are not separate diseases but parts of a spectrum of one entity – the lordogenetic midline congestion syndrome and thus often occur togetherQuantitative functional color Doppler Ultrasound is necessary for a comprehensive understandingThe pittoresque symptomatology is not a psychologic dramatization by the patient but the consequence of venous congestion of many organs – from toe to brainConnective tissue disorders predispose to vascular compressionsDisease progression and expansion is the ruleThe patient does not need a psychiatrist but a surgeon to treat her successfully