Superior mesenteric artery compression disorders

The superior mesenteric artery (SMA) originates from the anterior aspect of the abdominal aorta, just below the celiac trunk at the level of the L1 vertebra. Normally, the SMA is surrounded by fat and lymphatic tissues which provide a cushion between it and its surrounding structures. The mesenteric fat pad between the SMA and aorta forms a natural angle between them, called the aortomesenteric angle. The normal aortomesenteric angle is 25-60º. The aortomesenteric distance, the distance between aorta and SMA, is usually 10-28mm. Loss of this cushion of fat can lead to acute angulation of the SMA and reduction in the aortomesenteric distance. This in turn can cause extrinsic vascular compression of other structures by the SMA, giving rise to two distinct vascular compression disorders:
1) SMA syndrome (Wilkie’s syndrome) – compression of the third part of the duodenum by the SMA.
2)Renal vein entrapment (Nutcracker syndrome) – compression of the left renal vein by the SMA.

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