Biofluid Mechanics and Pathology of Venous Compression Syndromes: A Scoping Review.

Chronic venous disease (CVD) affects over 30 million individuals in the United States and imposes an annual economic burden of approximately $5 billion. Venous compression syndromes, defined as disorders caused by the extrinsic compression of veins at anatomically constrained sites, represent a significant yet underdiagnosed subset of CVD. Among these, May-Thurner Syndrome (MTS), the compression of the left common iliac vein by the right common iliac artery, is among the most clinically recognized. These syndromes often evade early detection due to the lack of specific non-invasive findings, resulting in delays between onset and diagnosis. This scoping review integrates current knowledge on the biophysical, molecular, and cellular mechanisms involved in venous compression syndromes, with a focus on how altered biofluid mechanics impact endothelial function and vascular pathology. Disruptions in these mechanical forces can lead to plasma membrane breaches, impaired endothelial cell repair, and downstream effects like neointimal hyperplasia, which further distort flow and promote a pathological cycle. The clinical consequences of these syndromes ultimately contribute to complications, such as venous stasis ulcers. This interdisciplinary review provides a synthesized framework for understanding how changes in biofluid mechanics lead to vascular remodeling and disease progression, supporting the development of improved diagnostic and therapeutic approaches.