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Visceral artery compression syndromes.

Arkadiusz Janion1, Radosław Kowalewski1

  • 1Departament of Surgery, Faculty of Medicine Collegium Medicum Cardinal Stefan Wyszyński University in Warsaw, Poland, Departament of General Vascular and Oncological Surgery, Międzylesie Specialist Hospital in Warsaw, Poland.

Polski Przeglad Chirurgiczny
|April 22, 2026
PubMed
Summary
This summary is machine-generated.

Visceral artery compression syndromes, including MALS, SMAS, and NCS, present ambiguous symptoms and are challenging to diagnose and treat. Minimally invasive techniques and better pathophysiology understanding can improve patient quality of life.

Keywords:
Dunbar syndromeMALSNCSSMASWilkie syndromenutcracker syndrome

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Area of Science:

  • Vascular Surgery
  • Gastroenterology
  • Diagnostic Imaging

Background:

  • Visceral artery compression syndromes are rare conditions with nonspecific symptoms.
  • These syndromes include medial arcuate ligament syndrome (MALS), superior mesenteric artery syndrome (SMAS), and nutcracker syndrome (NCS).
  • Diagnosis is often challenging due to overlapping symptoms and the need to exclude other pathologies.

Purpose of the Study:

  • To review the pathology, diagnosis, and treatment of visceral artery compression syndromes.
  • To highlight the diagnostic challenges and current therapeutic approaches for MALS, SMAS, and NCS.
  • To emphasize the importance of understanding pathophysiology and employing advanced techniques.

Main Methods:

  • Literature review based on a MEDLINE database search.
  • Analysis of diagnostic criteria and imaging modalities including Doppler ultrasound and computed tomography.
  • Evaluation of surgical and conservative treatment strategies.

Main Results:

  • MALS involves celiac trunk compression by the medial arcuate ligament; diagnosis is by exclusion, and treatment involves surgical decompression.
  • SMAS results from duodenal compression between the superior mesenteric artery and aorta; diagnosis relies on exclusion and imaging, with surgery often necessary.
  • NCS involves left renal vein compression by the superior mesenteric artery; diagnosis is by exclusion, and treatment is individualized.

Conclusions:

  • Visceral artery compression syndromes disproportionately affect women and pose significant diagnostic and therapeutic challenges.
  • Improved understanding of pathophysiology and utilization of minimally invasive techniques are crucial for enhancing patient outcomes.
  • Individualized treatment strategies are essential for managing these rare vascular conditions.