Czihal Michael, Banafsche Ramin, Hoffmann Ulrich, Koeppel Thomas
1 Division of Vascular Medicine, Medical Clinic and Policlinic IV, Vascular Center, Hospital of the Ludwig-Maximilians-University Munich, Germany.
2 Division of Vascular and Endovascular Surgery, Vascular Center, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
Vasa. 2015 Nov;44(6):419-34. doi: 10.1024/0301-1526/a000465.
Dealing with vascular compression syndromes is one of the most challenging tasks in Vascular Medicine practice. This heterogeneous group of disorders is characterised by external compression of primarily healthy arteries and/or veins as well as accompanying nerval structures, carrying the risk of subsequent structural vessel wall and nerve damage. Vascular compression syndromes may severely impair health-related quality of life in affected individuals who are typically young and otherwise healthy. The diagnostic approach has not been standardised for any of the vascular compression syndromes. Moreover, some degree of positional external compression of blood vessels such as the subclavian and popliteal vessels or the celiac trunk can be found in a significant proportion of healthy individuals. This implies important difficulties in differentiating physiological from pathological findings of clinical examination and diagnostic imaging with provocative manoeuvres. The level of evidence on which treatment decisions regarding surgical decompression with or without revascularisation can be relied on is generally poor, mostly coming from retrospective single centre studies. Proper patient selection is critical in order to avoid overtreatment in patients without a clear association between vascular compression and clinical symptoms. With a focus on the thoracic outlet-syndrome, the median arcuate ligament syndrome and the popliteal entrapment syndrome, the present article gives a selective literature review on compression syndromes from an interdisciplinary vascular point of view.
处理血管压迫综合征是血管医学实践中最具挑战性的任务之一。这类异质性疾病的特征是主要健康的动脉和/或静脉以及伴随的神经结构受到外部压迫，存在随后血管壁和神经结构损伤的风险。血管压迫综合征可能会严重损害受影响个体的健康相关生活质量，这些个体通常较为年轻且其他方面健康。对于任何一种血管压迫综合征，诊断方法都尚未标准化。此外，在相当一部分健康个体中，可以发现诸如锁骨下血管、腘血管或腹腔干等血管存在一定程度的体位性外部压迫。这意味着在通过激发性操作将临床检查和诊断成像的生理发现与病理发现区分开来时存在重大困难。关于是否进行手术减压及是否进行血运重建的治疗决策所依据的证据水平通常较低，大多来自回顾性单中心研究。为避免对血管压迫与临床症状无明确关联的患者进行过度治疗，正确选择患者至关重要。本文聚焦于胸廓出口综合征、正中弓状韧带综合征和腘动脉压迫综合征，从跨学科血管角度对压迫综合征进行了选择性文献综述。
