Symptoms were hematuria, proteinuria or flank pain. Developed by renowned radiologists in each specialty, statdx provides comprehensive decision support you can rely on nutcracker syndrome. Some people may not have symptoms, while others develop severe and persistent symptoms. Management options include endovascular stenting of the compressed segment of the left renal vein, or. We report the efficacy and safety of endovascular stenting for nutcracker syndrome at longterm followup. Endovascular today issn 15511944 print and issn 2689792x online is a publication dedicated to bringing you. The first case report of endovascular stent placement for renal vein hypertension was in 1996 by neste et al who described a 58yearold man successfully treated with a wallstent boston scientific corporation, natick, ma. The nutcracker syndrome is an emerging indication for venous endovascular stenting. Although endovascular stenting is an attractive option, it is not without complications. Nutcracker syndrome, first reported in 1972, is characterized by hematuria and back pain caused by increased pressure in the lrv as a result of compression between the aorta and the sma.
Nutcracker syndrome results from compression of the left renal vein lrv between the aorta and the superior mesenteric artery sma. Nutcracker syndrome, caused by left renal vein lrv compression as it passes between the superior mesenteric artery and aorta, causes. Nov 06, 2014 endovascular stenting is an alternative treatment option. A 26yearold woman with a history of hematuria and left flank pain was admitted. Intermittent hematuria and orthostatic proteinuria with or without abdominal or flank pain are the common clinical manifestations. Endovascular stent placement for the treatment of nutcracker. Hematuria, pelvic or back pain and left varicocele are the most commonly symptoms. Pelvic pain recurred in one patient who had initially improved, and. Endovascular angioplasty with stenting cas treatment. Although endovascular stenting is well accepted for iliocaval occlusive disease, it has been.
Extravascular stent management for migration of left renal. Cgsurg106 venous angioplasty with or without stent. Endovascular stenting for treatment of nutcracker syndrome. Results of endovascular treatment for patients with. A patient presented with recurrent macroscopic hematuria, persistent orthostatic proteinuria and intermittent flank pain for 12 months. This can lead to obstruction of flow into the inferior vena cava and secondary left renal venous hypertension. Followup was completed by clinical exams and duplex ultrasound at. We present a case of a 54yearold female with chronic lower abdominal pain radiating to the left thigh of 4 years in duration.
A case report of a young girl with recurrent hematuria. In addition to conservative measures, more invasive therapies include endovascular stenting, renal vein reimplantation, and gonadal vein embolization. Its diagnostic criteria are not well defined, often causing delayed or misdiagnosis. Venous compression treatment adelaide, sa may thurner. Doppler ultrasound, computed tomography angiography and selective renal vein phlebography revealed the compression of the left renal vein by the abdominal aorta. 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. Once the catheter is in place, a balloon may be inflated to open the artery and a stent is placed. The patient was diagnosed with nutcracker syndrome and underwent endovascular stent placement. Results are encouraging at followup periods beyond two. As pain management specialists, we should include nutcracker syndrome in the differential when the symptoms indicate, and not simply assume atypical left flank pain is chronic myofascial or due to lower rib pathology. Materials and methods we retrospectively evaluated the endovascular stenting experience with 61 patients with a median age of 26 years. Endovascular treatment of nutcracker syndrome scielo. Our case report confirms nutcracker syndrome may be treated through endovascular means, eliminating symptoms and providing a durable alternative to open surgery. We describe a case of a 28yearold man who presented with microscopic hematuria, leftsided flank pain, and testicular swelling.
Renal vein stenting for nutcracker syndrome a potentially lessinvasive treatment for a rare but debilitating condition. 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. 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. We describe a case of a 28yearold man who presented with microscopic hematuria, left. 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. Pain is a result of the inflammatory cascade triggered by venous hypertension. A 30yearold female was diagnosed with nutcracker syndrome for severe left flank pain. Nutcracker syndrome treated by endovascular stenting of the left. Pdf nutcracker syndrome ncs is a rare pathology manifested by pain or hematuria in males and females alike. Nutcracker syndrome is a clinical entity leading to renal venous hypertension due to extrinsic compression of the left renal vein by the superior mesenteric artery. Nutcracker syndromean unusual case of chronic left upper. Once symptoms occur its called nutcracker syndrome. Jul 14, 2017 posts about nutcracker syndrome written by docpark. Nutcracker syndrome is an important cause of pelvic pain and consists of a set of signs secondary to compression of the left renal vein, most commonly between the superior mesenteric artery and the aorta.
As more cases are reported, endovascular repair is becoming an alternative treatment for nutcracker syndrome. Outcomes of left renal vein stenting in patients with nutcracker. 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. Hansraj n, hamdi a, khalifeh a, wise e, sarkar r, toursavadkohi s. The alternative option of endovascular or extravascular stenting is very appealing because of the minimal invasive procedures. A potentially lessinvasive treatment for a rare but debilitating condition. It is characterized by external compression of the out. Chen and colleagues 2011 retrospectively evaluated the endovascular stenting of 61 individuals with nutcracker syndrome and a median age of 26 years. When the condition shows no symptoms, its usually known as nutcracker phenomenon. It can be preferred to open surgery because of the long period of renal congestion.
Apr 15, 2019 percutaneous endovascular stenting of the lrv has shown longterm symptom resolution as well. Policha a, lamparello p, sadek m, berland t, maldonado t 2016 endovascular treatment of nutcracker syndrome. 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. 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. 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. Extravascular stent management for migration of left renal vein. Endovascular technology has evolved as a potential minimally invasive therapy for relief of symptoms caused by this compression syndrome.
It can be easily overlooked, and should be considered in young men or women with symptoms of extended duration. This only slightly invasive treatment can eliminate the symptoms of the condition. Noninvasive ultrasound and crosssectional imaging can show the anatomic. Nutcracker syndrome is a rare diagnosis and may manifest in unusual ways. Doppler ultrasound, computed tomography ct and selective left renal vein phlebography are useful to confirm.
Endovascular stenting in the treatment of pelvic vein congestion. Nutcracker syndrome is a rare condition that can be successfully treated with renal vein stenting via an endovascular approach. Endovascular management of nutcracker syndrome after. Nutcracker syndrome ncs is a rare entity defined by the symptomatic hypertension of the left renal vein lrv compressed in the majority of cases between the superior mesenteric artery and the aorta. Hartung o, grisoli d, boufi m, marani i, hakam z, et al. Nutcracker syndrome encompasses classical symptoms of hematuria and flank pain resulting from the compression of the left renal vein between the aorta and the superior mesenteric artery. Followup was completed by clinical exams and duplex ultrasound at 3, 6 and 12 months. Nutcracker syndrome treated by endovascular stenting of the left renal vein. Here, the left renal vein which drains the blood from the left kidney is compressed like a nutcracker between the abdominal aorta behind and the superior mesenteric artery in front. Jun 22, 2017 endovascular stenting in the treatment of pelvic vein congestion caused by nutcracker syndrome. While traditionally treated with open surgery, the last several years have seen increased utilization of an endovascular approach through stenting of the lrv.
Stenting can be used, provided that the same techniques as those in the maythurner syndrome are used, that is, the stent should protrude into the inferior vena cava. Nutcracker syndrome ncs is a rare pathology manifested by pain or hematuria in males and females alike. Scvs endovascular treatment of nutcracker syndrome. 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. Nutcracker syndrome is also known as the left renal vein entrapment syndrome. Ultimately, ncs should be suspected in young men or women with symptoms of lengthy duration, and endovascular stenting for symptomatic lrv compression may be an effective and safe treatment. Renal vein stenting for nutcracker syndrome endovascular. At the threeweek followup, she reported near resolution of nausea and abdominal pain. This is because both mts and pcs are anatomic variants in the structure of abdominal veins that predispose the patient to all three issues. She underwent successful extravascular stenting with complete symptom. Although open surgical approaches remain the treatment of choice, endovascular stenting has been used successfully. The stent will be placed in your vein by the surgeon after the surgeon makes a small puncture in the leg. Hybrid intervention for treatment of the nutcracker syndrome.
In conclusion, ncs is a rare pathology manifested by pain with or without microscopic or gross hematuria. A case of hematuria and flank pain renal and urology news. Endovascular treatment of nutcracker syndrome request pdf. Case studies gastroenterology unusual confluence of two rare syndromes results in peculiar symptoms interpretation of an ultrasound exam made all the difference in creating a treatment plan. More recently, endovascular stenting of the left renal vein has been reported. Endovascular stent placement for nutcracker phenomenon. Endovascular management of recurrent stenosis following left. Nutcracker syndrome is an easily missed cause of hematuria in children. Follow up computed tomography with intravenous contrast showed a widely patent stent. Endovascular management of recurrent stenosis following left renal vein transposition for the treatment of nutcracker syndrome donald t.
The patient was diagnosed with nutcracker syndrome and underwent. Current surgical therapy involves placement of an oversized renal vein stent with partial protrusion into the inferior vena cava ivc to relieve stenosis and prevent stent migration. Nutcracker syndrome is a very common condition that is present in almost 50% of women with other forms of pelvic vein disease, such as may thurner syndrome mts and pelvic congestion. In cases of nutcracker syndrome, the left renal vein was stenosed between the. Doppler ultrasound, computed tomography ct and selective left. It can be easily overlooked, and should be considered in young men or women with symptoms. Outcomes of left renal vein stenting in patients with nutcracker syndrome. Unusual confluence of two rare syndromes results in. Despite potential serious consequences, diagnosing ncs is often challenging, circuitous and commonly delayed. 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. The patient was treated with stenting of her left renal vein.
Introduction nutcracker syndrome ncs, or renal vein entrapment syndrome, is a rare and easily overlooked condition. Although surgical repair has been the standard of care, more recently. Endovascular stent placement as a treatment for renal venous hypertension. Symptoms included pelvic and flank pain in all 3 patients, and episodes. 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. Venous stents may lead to fibromuscular hyperplasia, embolization and proximal migration which may be fatal. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration or. Renal vein stenting for nutcracker syndrome endovascular today. Posts about nutcracker syndrome written by docpark.
We retrospectively evaluated the endovascular stenting experience with 61 patients with a median age of 26 years. Management options include endovascular or laparoscopic extravascular stent placement, which is very appealing given the minimally invasive nature of these procedures. Six months after the nausea began, she started having syncope, sometimes multiple episodes in one day. Posterior nutcracker syndrome occurs when a retroaortic left renal vein becomes compressed between the abdominal aorta and the lumbar spine. Nutcracker syndromean unusual case of chronic left upper ab. Endovascular stenting is an alternative treatment option. After failed conservative approach, she underwent endovascular stenting. In most cases, compression of the left renal vein is between the abdominal aorta the main artery in the abdomen and the superior mesenteric artery, which brings blood. Clinicians place an endovascular stent in the left renal vein.
It is characterized by left renal vein entrapment between the abdominal aorta and the superior mesenteric artery causing renal venous hypertension. D baylor university medical center, dallas, tx, usa. Endovascular management of recurrent stenosis following. Renal nutcracker syndrome genetic and rare diseases. Stents in the renal vein can cause fibromuscular hyperplasia. A novel hybrid left renal vein transposition and endovascular. After failed conservative approach, she underwent endovascular stenting and subsequently developed recurrent symptom for stent migration one month postoperatively. Chronic pelvic pain is a debilitating disease that directly impacts on quality of life and generates costs for health services. Syncope is one of the more rarely reported symptoms associated with nutcracker syndrome. Percutaneous endovascular stenting of the lrv has shown longterm symptom resolution as well.
Endovascular stenting for nutcracker syndrome sciencedirect. We describe a case of a 28yearold man who presented with microscopic hematuria, leftsided flank pain, and. Nutcracker syndrome ncs is caused by compression of left renal vein lrv, usually between the aorta and the superior mesenteric artery sma. 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. Pdf endovascular stenting for nutcracker syndrome researchgate. Nutcracker syndrome, or mesoaortic compression of the left renal vein. Nutcracker syndrome is another rare example of venous compression. Thrombosis, stent migration, fracture and restenosis are the complications of the endovascular stenting but they are rare. Division of vascular surgery, department of surgery, university of pittsburgh. Endovascular stenting in the treatment of pelvic vein.