Multispiral computed tomography upper-level arteriovenous conflicts (abdominal cavity and retroperitoneal space)

Introduction. Continuous improvement and increased availability of high-tech research methods, such as computed X-ray tomography (CT) and magnetic resonance imaging (MRI) with contrast enhancement, qualitatively change the diagnostic search for combined vascular pathology, including when conducting studies of other organs and systems, even in the absence of any clinical manifestations.

The purpose of the study: to evaluate the possibilities and determine the indications for CT diagnosis of arteriovenous conflicts of the abdominal cavity, retroperitoneal space.

Research objectives: to determine CT parameters and the algorithm of CT analysis of upper-level arteriovenous conflicts in modern radiation and urological aspects.

Materials and methods. The study included 34 patients with arteriovenous conflicts of the abdominal cavity and retroperitoneal space detected by computer X-ray tomography. The average age of patients is 39±11.0 years; the number of male patients is 19 (55.9%), female — 15 (44.1%). Children’s patients accounted for 23.5% (8 people; average age 11±7 years). The preoperative diagnostic algorithm included a clinical examination, ultrasound diagnostics, a comprehensive study of laboratory parameters, CT-arterio/venography.

The results of the study. Among the upper—level arteriovenous conflicts, superior mesenteric artery syndrome prevailed — it was observed in 23 patients (67.6%), of which aortomesenteric duodenal compression (Wilkie syndrome) was detected in 12 patients (52.2%); aortomesenteric venous compression (Nutcracker syndrome) — in 11 patients (47.8%). Among children’s patients, aortomesenteric tweezers prevailed (5 patients — 62.5%). A combination of upper-level syndromes was detected in 6 patients (17.6%). Compression syndrome of the left renal vein (aortovertebral venous compression, posterior nutcracker syndrome), or Nutcracker syndrome was detected in 11 patients (32.4%), which in all cases (100%) was a «random finding» of CT diagnostics.

Conclusions. It is recommended to perform CT-, MR-studies with contrast enhancement (in angiography mode) in patients with a suspected diagnosis of arteriovenous conflict with the expansion of the scanning zone to the level of the abdominal cavity, retroperitoneal space and pelvis in order to exclude combined multi-level vascular pathology. Mandatory for radiation analysis are the magnitude of the aortomesenteric angle, the magnitude of the aortomesenteric distance for the left renal artery, the magnitude of the aortovertebral distance for the left renal artery, the magnitude of the aortomesenteric distance for the duodenum; analysis of concomitant variant vascular pathology at the levels studied. 

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