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Paulina Bruessel,1,* Mogeshni Govender,2,* Gert Frahm-Jensen1 1Department of Vascular Surgery, The Canberra Hospital, Canberra, ACT, Australia; 2Department of Rheumatology, The Canberra Hospital, Canberra, ACT, Australia*These authors contributed equally to this workCorrespondence: Paulina Bruessel, The Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia, Email Paulina.Bruessel@act.gov.auObjective: Abdominopelvic Vascular Compression Syndrome(s) (VCS) are rare disorders with diverse symptoms that appear to occur more frequently in patients with Ehlers–Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD). The reported associations between EDS/HSD, Postural Orthostatic Tachycardia Syndrome (POTS), and Mast Cell Activation Syndrome (MCAS) further complicate the diagnosis and management of the VCS in this specific patient population. This review summarises the established literature on this complex topic, highlighting these relationships, with the aim to propose a framework for recognising and managing VCS among patients with EDS/HSD. Given the limited body of literature on this topic, we also aim to underscore the need for further research within this specific patient population.Methods: A PRISMA-guided systematic review was conducted using PubMed and Ovid/Medline databases. VCS included Median Arcuate Ligament Syndrome (MALS), Superior Mesenteric Artery Syndrome (SMAS), Nutcracker Syndrome (NCS), and May–Thurner Syndrome (MTS). Given the limited number of studies, small cohort studies and case reports/series were also reviewed.Results: Of 183 screened studies, 62 met the inclusion criteria. Only six studies directly addressed the VCS in EDS/HSD. Five discussed an EDS–POTS association, two described links between MCAS, POTS, and EDS, and five associated POTS with VCS. Only one study explored all four conditions.Conclusion: Evidence suggests an association between EDS/HSD, VCS, POTS, and MCAS but remains limited. Underdiagnosis and delayed treatment are common and underscore the need for multi-disciplinary care. Invasive imaging and interventions appear generally safe in EDS/HSD, excluding vascular EDS, yet robust safety and outcome data and tailored diagnostic or treatment algorithms are lacking and require further investigation.Keywords: Ehlers–Danlos syndrome, EDS, hypermobility spectrum disorder, HSD, median arcuate ligament syndrome, MALS, mast cell activation syndrome, MCAS, May–Thurner syndrome

The maturation of autogenous arteriovenous fistulas (AVFs) remains unpredictable despite being the preferred vascular access for haemodialysis. Early identification of at-risk AVFs could improve outcomes and reduce unnecessary interventions. The 2019 Kidney Disease Outcomes Quality Initiative (KDOQI) recommends a volume flow (Qa) threshold of >500 mL/min, replacing the 2006 >600 mL/min benchmark, as a marker of fistula health. This study evaluates whether perioperative and follow-up Qa measurements are associated with AVF maturation, with particular focus on pre-operative and immediate post-operative Qa, which remain underexplored. The influence of anaesthetic and demographic factors was also assessed. This single-centre retrospective cohort study included 31 patients undergoing AVF creation. Inflow artery Qa was measured pre-operatively, immediately post-operatively, and at follow-up. Demographics, comorbidities, anaesthetic parameters, and AVF characteristics were obtained from clinical records. Successful maturation was defined as Qa ≥500 mL/min on duplex ultrasound at six weeks and the ability to sustain dialysis (two-needle access for ≥ two-thirds of sessions in the first month without functional concerns). Of 31 AVFs created, 22 (71%) matured by follow-up, either directly (n = 15, median Qa 1050 mL/min) or after fistuloplasty (n = 7, median Qa 800 mL/min). Nine (29%) failed to mature of which six did not undergo fistuloplasty (median Qa 270 mL/min), and three failed despite fistuloplasty (median Qa 332 mL/min). Successful AVFs demonstrated higher median Qa pre-operatively (91 vs 70 mL/min, p = 0.08), post-operatively (495 vs 234 mL/min, p = 0.02), and at follow-up (925 vs 280 mL/min, p < 0.001). The majority of AVF with Qa >700 mL/min at follow-up matured (OR 22.17, 95% CI 3.25-151.3, p = 0.002). No significant associations were found with age, smoking, diabetes, or anaesthetic factors. Perioperative Qa measurement is a practical, low-cost predictor of AVF maturation. The >500 mL/min Qa threshold supports current KDOQI guidance. Pre-operative Qa differences represent a promising area for future research, while demographic and anaesthetic factors showed limited predictive value.

Elizabeth Vacher, Paulina Bruessel UCL Medical School, London, WC1E 6DE, UKCorrespondence: Elizabeth Vacher Email Elizabeth.Vacher.14@ucl.ac.uk View the original paper by Dr Qian and colleagues