Vascular Compression Syndromes

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.75
Procedures: 2.75
Head, Spine, and Musculoskeletal: 0.75
Neck and Chest: 1.25
Abdomen and Pelvis: 0.75

Magnetic Resonance Imaging: 2.75
Procedures: 2.75
Body: 2.00
Musculoskeletal: 0.75

Registered Radiologist Assistant: 3.75
Procedures: 3.75
Neurological, Vascular, and Lymphatic Sections: 3.75

Sonography: 2.75
Procedures: 2.75
Abdomen: 0.75
Superficial Structures and Other Sonographic Procedures: 2.00

Vascular-Interventional Radiography: 3.75
Procedures: 3.75
Vascular Diagnostic Procedures: 3.75

Vascular Sonography: 2.75
Procedures: 2.75
Abdominal/Pelvic Vasculature: 1.50
Arterial Peripheral Vasculature: 0.50
Venous Peripheral Vasculature: 0.50
Extracranial Cerebral Vasculature and Other Sonographic Procedures: 0.25

Outline

1. Introduction
2. Thoracic Outlet Syndrome
   1. Anatomy
   2. Pathophysiology
   3. Symptoms and Signs
   4. Diagnostic Evaluation
   5. Radiologic Imaging
      1. Radiography
      2. Doppler US
      3. CT Angiography
      4. MR Angiography
      5. Conventional Angiography
   6. Management
3. Paget-Schrotter Syndrome
4. Quadrilateral Space Syndrome
   1. Imaging Evaluation
      1. Conventional Angiography
      2. MR Imaging
   2. Management
5. Median Arcuate Ligament Syndrome
   1. Imaging Evaluation
      1. Conventional Angiography
      2. CT Angiography
      3. MR Angiography
   2. Management
6. Nutcracker Syndrome
   1. Imaging Evaluation
      1. Doppler US
      2. CT and MR Angiography
      3. Conventional Venography
   2. Management
7. May-Thurner (Cockett) Syndrome
   1. Imaging Evaluation
      1. Doppler US
      2. Conventional Venography
      3. MR Venography
      4. CT Venography
   2. Management
8. Popliteal Artery Entrapment Syndrome
   1. Imaging Evaluation
      1. Doppler US
      2. CT Angiography
      3. MR Angiography
      4. Conventional Angiography
   2. Management
9. Conclusions

Objectives

Upon completion of this course, students will:

1. be aware of what portion of the population is affected by vascular compression
2. list the imaging modalities which are used in the diagnosis of vascular compression syndrome
3. know the three types of thoracic outlet syndrome
4. be aware of thoracic outlet anatomy
5. know what areas of the thoracic outlet are most and least affected by vascular compression syndrome
6. define thenar wasting
7. understand B-mode ultrasound in the diagnosis of TOS
8. know what percentage of patients have bilateral limb involvement with regard to subclavian vein thrombosis
9. discuss the three treatment options for TOS
10. know the most invasive type of treatment for TOS
11. know what type of upper extremity movement is associated with Paget-Schroetter syndrome
12. be aware of the vessel affected in Paget-Schroetter syndrome
13. understand what positioning is utilized for DSA in the diagnosis of QSS
14. know what two conditions demonstrate symptoms similar to QSS
15. note what artery is affected by median arcuate ligament syndrome
16. list clinical features of median arcuate ligament syndrome
17. discuss why angiography for median arcuate ligament syndrome is performed with the patient in the lateral position
18. know what main finding is evident on both CTA and DSA when imaging for MALS
19. understand why CTA is preferred over MRA when imaging for MALS
20. know what vessel is compressed in nutcracker syndrome
21. express the most common symptom of nutcracker syndrome
22. know the anatomic placement of the superior mesenteric artery and the abdominal aorta on CT and MR angiograms
23. know the pressure gradient measurement that is considered diagnostic of NCS
24. list the three treatment options for NCS
25. note the newest treatment for NCS
26. understand what vessel is affected by May-Thurner syndrome
27. know the causes of May-Thurner syndrome
28. list the symptoms of May-Thurner syndrome
29. understand why Doppler ultrasound does not always reveal vessel compression when attempting to diagnose May-Thurner Syndrome
30. verbalize how MR venography is used in the diagnosis of MTS
31. know the treatment and management options for MTS
32. describe what two motions of the foot cause compression of the popliteal artery
33. understand the advantages of CTA when imaging the popliteal artery
34. know what two diagnostic studies produce similar levels of accuracy in the diagnosis of popliteal artery entrapment syndrome
35. discuss the benefits of early detection and treatment of popliteal artery entrapment syndrome