CTA-Derived Aortomesenteric Measurements and Demographic Characteristics in Surgically Treated Patients with Wilkie's Syndrome: A Single-Center Retrospective Study

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Introduction. Superior mesenteric artery syndrome (SMAS), or Wilkie’s syndrome, is a rare vascular compression disorder characterized by the compression of the third portion of the duodenum between the abdominal aorta and the superior mesenteric artery (SMA). This study aimed to describe computed tomography angiography (CTA)-derived aortomesenteric distance and angle measurements and to evaluate their associations with age and sex in surgically treated patients with Wilkie’s syndrome at a single tertiary center. Methods. We retrospectively reviewed records of 50 patients who underwent surgical treatment for SMAS between January 2015 and May 2024. Aortomesenteric measurements were performed on abdominal CTA images using TomoCon®, a Slovak DICOM viewing software. Descriptive and inferential statistics were applied to analyze the aortomesenteric distance (AMD), aortomesenteric angle (AMA), and demographic variables. Results. The median AMD was 6.55 mm [4.63 – 7.98], and the median AMA was 18.20° [13.98 – 21.38], both within the ranges commonly reported in SMAS and lower than published reference values. The median patient age was 33.95 years [23.78 – 47.83], with a pronounced female predominance (female-to-male ratio of 4.56:1). A moderate positive correlation was observed between AMD and AMA. No significant differences in AMD, AMA, or age were found between females and males. Conclusions. Surgically treated patients with Wilkie’s syndrome had lower CTA-derived AMD and AMA than those reported in published reference populations. The cohort was characterized by a predominance of younger female patients, consistent with previous reports.

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