At the threeweek followup, she reported near resolution of nausea and abdominal pain. Nutcracker syndrome should not be confused with superior mesenteric artery syndrome wilkie syndrome also a superior mesenteric artery compression disorder, where the sma compresses the third part of the duodenum the two conditions, however, may be associated. Left renal vein entrapment syndrome, characterized by the compression of the left renal vein lrv between the superior mesenteric artery sma and the abdominal aorta was first described in 1950. Posts about nutcracker syndrome written by docpark. Some people may not have symptoms, while others develop severe and. To retrospectively assess the therapeutic value of endovascular stenting for treatment of the nutcracker syndrome ncs in longterm followup and to explore the selection of the size of stents in chinese patients with ncs. Endovascular treatment of nutcracker syndrome request pdf. The renal venous hypertension caused by ncs can be severe enough to lead to formation of an aneurysm and development of hydronephrosis. The nutcracker syndrome ncs results most commonly from the compression of the left renal vein lrv between the abdominal aorta aa and superior mesenteric artery sma, although other variants exist. Open, laparoscopic, and endovascular techniques have been developed to decrease the venous outflow obstruction of the lrv. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration or.
Jul 14, 2017 posts about nutcracker syndrome written by docpark. Nutcracker syndrome is a variation of nutcracker phenomenon or renal vein entrapment syndrome, in which the arteries near the kidney compress the left renal kidney vein. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration. Minimally invasive treatment options are a safe and feasible alternative for treatment of nutcracker syndrome. Once the catheter is in place, a balloon may be inflated to open the artery and a stent is placed. Nutcracker syndrome and radiographic evaluation of loin pain. In cases of nutcracker syndrome, the left renal vein was stenosed between the. Current management approach for left renal vein entrapment. A 30yearold female was diagnosed with nutcracker syndrome for severe left flank pain. After failed conservative approach, she underwent endovascular stenting. After failed conservative approach, she underwent endovascular stenting and subsequently developed recurrent symptom for stent migration one month postoperatively. Nutcracker syndrome is an entity resulting from left renal vein compression by. Endovascular stenting of the renal vein has been reported for nutcracker syndrome with a promising safety and efficacy profile.
Nov 22, 2017 although endovascular stenting is an attractive option, it is not without complications. Extravascular stent management for migration of left renal. A simplified approach with gonadal vein transposition posted on june 12, 2016 june 12, 2016 by docpark the patient is a young woman in her twenties who developed severe right sided abdominal and back pain about 4 months prior to presentation associated with bouts of bloody urine. Symptoms were hematuria, proteinuria or flank pain. Pdf nutcracker syndrome ncs is a rare pathology manifested by pain or hematuria. We describe a case of a 28yearold man who presented with microscopic hematuria, leftsided flank pain, and testicular swelling. Nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the.
Further studies should report if this approach has adverse effects and if such a. Nutcracker syndrome is a rare condition that can be successfully treated with renal vein stenting via an endovascular approach. Endovascular stenting in the treatment of pelvic vein congestion. Results are encouraging at followup periods up to 2 years. Endovascular treatment of nutcracker syndrome journal of. Imaging findings and clinical features of abdominal. Nutcracker syndrome servier phlebolymphologyservier. Hansraj n, hamdi a, khalifeh a, wise e, sarkar r, toursavadkohi s. Endovascular stenting is an alternative treatment option. It can be preferred to open surgery because of the long period of renal congestion, additional anastomoses and extensive dissection requirement of the open surgery. We describe a case of a 28yearold man who presented with microscopic hematuria, left. Followup was completed by clinical exams and duplex ultrasound at 3, 6 and 12 months.
Endovascular stenting for nutcracker syndrome kuokang feng, chunyang huang, chenyuan hsiao, tsunghsing lee, tzuting kuo. Transposition of the left renal vein for treatment of the nutcracker phenomenon. While traditionally treated with open surgery, the last several years have seen increased utilization of an endovascular approach through stenting of the lrv. After a successful endovascular stenting and a 6month period of antiplatelet and anticoagulant therapy, the patient returned to stable health. Open, laparoscopic, and endovascular techniques have been developed to decrease the venous outflow obstruction of. Endovascular treatment by stenting was proposed and is not very invasive, but followup is too short to establish the role of this technique in the management of the nutcracker syndrome. Nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the superior mesenteric artery, which leads to symptoms of hematuria or left flank pain. Nutcracker syndrome is a rare diagnosis and may manifest in unusual ways.
Nutcracker syndrome results from compression of the left renal vein between the superior mesenteric artery and the aorta, leading to symptoms of hematuria and left flank pain. A novel hybrid left renal vein transposition and endovascular. Endovascular stenting for nutcracker syndrome sciencedirect. Endovascular stent placement for nutcracker phenomenon. N2 minimally invasive treatment options are a safe and feasible alternative for treatment of nutcracker syndrome. Nutcracker syndrome ncs may present with just leftsided flank pain. Though lrv transposition and now lrv stenting are commonly employed methods for treatment of nutcracker syndrome, judicious management of ncs should take into consideration patients age, severity, and chronicity of symptoms along with current lack of data regarding longterm outcomes of stent placement. Renal nutcracker syndrome ncs is a condition that occurs when the left renal vein the vein that carries blood purified by the left kidney becomes compressed. Nutcracker syndrome ncs describes left renal vein compression. Endovascular treatment of nutcracker syndrome scielo. The alternative option of endovascular or extravascular stenting is very appealing because of the minimal invasive procedures. Posterior nutcracker syndrome occurs when a retroaortic left renal vein becomes compressed between the abdominal aorta and the lumbar spine.
Results are encouraging at followup periods beyond 2 years. Nutcracker syndrome and radiographic evaluation of loin. Robotassisted laparoscopic extravascular stent for. Management options include endovascular or laparoscopic extravascular stent placement, which is very appealing given the minimally invasive nature of these procedures.
Nutcracker syndromean unusual case of chronic left upper ab. Syncope is one of the more rarely reported symptoms associated with nutcracker syndrome. Hybrid intervention for treatment of the nutcracker syndrome. Nutcracker syndromean unusual case of chronic left upper.
Nutcracker syndrome results from compression of the left renal vein lrv between the aorta and the superior mesenteric artery sma. Results of endovascular treatment for patients with. Management options can range from conservative to surgical, with the endovascular approach becoming an increasingly common one. The nutcracker syndrome is a rare clinic condition associated with severe hematuria and left flank pain due to the entrapment of the left renal vein between the superior mesenteric artery and the aorta. Carotid artery angioplasty with stenting cas is a minimally invasive procedure in which a very small hollow tube, or catheter, is advanced from a blood vessel in the groin to the carotid arteries. The first case report of endovascular stent placement for renal vein. Nutcracker syndrome or mesoaortic compression of the left renal vein lrv with associated symptoms related to venous hypertension in the left kidney is a rare entity that may result in severe symptoms requiring operative intervention. Endovascular stenting for treatment of nutcracker syndrome. The exact prevalence of nutcracker syndrome is unknown, likely because of the variable presenting features. Extravascular stent management for migration of left renal vein. We opted for the endovascular approach as it is was the least invasive option and is of proven efficacy in addition to the fact that our patient was opposed to the idea of surgical intervention. As more cases are reported, endovascular repair is becoming an alternative treatment for nutcracker syndrome. Since some of these causes are potentially serious and may be treatable if identified early, it is important to establish a. Endovascular management of nutcracker syndrome after.
Endovascular stenting in the treatment of pelvic vein congestion caused by nutcracker syndrome. Renal vein stenting for nutcracker syndrome endovascular today. Although endovascular stenting is an attractive option, it is not without complications. Additionally, this method can be successfully used in the treatment of posterior nutcracker syndrome. Extravascular stent management for migration of left renal vein endovascular stent in nutcracker syndrome lu tian1, shanwen chen2, gaoyue zhang3, hongkun zhang1, wei jin1 and ming li1 abstract background. Laparoscopic extravascular stent placement has shown promising results with the potential to avoid these complications. She underwent successful extravascular stenting with complete symptom resolution. Jul 24, 2015 nutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the superior mesenteric artery, which leads to symptoms of hematuria or left flank pain. Nutcracker phenomenon and nutcracker syndrome are sometimes used interchangeably in literatures. Left renal vein balloon venoplasty without stenting for.
Renal vein stenting for nutcracker syndrome endovascular. Figure 5 placement of the stent in the left renal vein. Nutcracker syndrome european journal of vascular and. Chen and colleagues 2011 retrospectively evaluated the endovascular stenting of 61 individuals with nutcracker syndrome and a median age of 26 years. Chen et al have shown, in a longer followup of 61 patients, that endovascular stenting is a primary option for ncs. Typically, a selfexpanding nitinol or stainless steel stent is used. More recently, endovascular stenting of the left renal vein has been reported. Thrombosis, stent migration, fracture and restenosis are the complications of the endovascular stenting but they are rare. Nutcracker syndrome symptoms, treatment, causes, surgery. Current trends in the diagnosis and management of renal. Although both terms are clinically equivalent, the latter is used for patients who are manifesting the characteristic clinical symptoms of the disorder 2.
Its diagnostic criteria are not well defined, often causing delayed or misdiagnosis. Aug 31, 2017 minimally invasive treatment options are a safe and feasible alternative for treatment of nutcracker syndrome. The severity of nutcracker syndrome is variable, and affected individuals may be completely asymptomatic or, in the most extreme. After a successful endovascular stenting and a 6month period of antiplatelet and. Both open and endovascular approaches to the treatment of this condition have been described in the literature. Patient is a 43 year old woman who had been having bouts of severe left sided abdominal pain for several years with worsening episodes of nausea and vomiting resulting in several visits to the emergency room. Cgsurg106 venous angioplasty with or without stent. Nutcracker syndrome ncs, or renal vein entrapment syndrome, is a rare and. Endovascular angioplasty with stenting cas treatment. Although open surgical approaches remain the treatment of choice, endovascular stenting has been used successfully. A simplified approach with gonadal vein transposition posted on june 12, 2016 june 12, 2016 by docpark the patient is a young woman in her twenties who developed severe right sided abdominal and back pain about 4 months prior to. Endovascular treatment of nutcracker syndrome sciencedirect. Renal nutcracker syndrome genetic and rare diseases. There are various underlying pathologic causes, including renal or ureteric calculi or tumors, intrinsic kidney disease including glomerulonephritis, and loin pain hematuria syndrome.
The name derives from the fact that, in the sagittal plane andor transverse plane, the sma and aa with some imagination appear to be a. Although surgical repair has been the standard of care, more recently endovascular stenting of the renal. Although endovascular stenting is well accepted for iliocaval occlusive disease. Lrv transposition is the most commonly described surgical approach successfully utilized to alleviate pelvic congestion symptoms and hematuria.
Results are encouraging at followup periods beyond two. Dec 21, 2009 loin pain and hematuria are common symptoms, presenting in patients of all ages. Venous stents may lead to fibromuscular hyperplasia, embolization and proximal migration which may be fatal. Hartung o, grisoli d, boufi m, marani i, hakam z, barthelemy p, et al. Minimally invasive treatments for venous compression syndromes. Although nutcracker syndrome ns is rare, patients presenting with symptoms or signs and anatomic compression of the left renal vein lrv can be considered for intervention. Loin pain and hematuria are common symptoms, presenting in patients of all ages. Endovascular stenting has shown promising longterm resolution of symptoms but can be complicated by stent migration or thrombosis.