Left renal venous hypertension “nutcracker” syndrome

Stewart, Bruce H.; Reiman, Girt

doi:10.1016/0090-4295(82)90457-5

Cited by 90 publications

(20 citation statements)

References 15 publications

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“…Clinical treatment is indicated when symptoms are tolerable, such as mild hematuria and pelvic pain that can be controlled with analgesics 13 . Surgical treatment is indicated in cases with persistent hematuria associated with anemia, functional renal failure and uncontrolled pelvic pain, or if conservative treatment is ineffective after 2 years' clinical follow-up [14][15][16][17] . In the case described here, the patient had already been on clinical treatment for a long time, without effective control of the pelvic symptoms being achieved and with persistent intermittent hematuria.…”

Section: Discussionmentioning

confidence: 99%

Tratamento endovascular da Sindrome de Quebra-nozes (Nutcracker)

Cunha

Souza

Feitosa³

et al. 2013

J. vasc. bras.

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Nutcracker syndrome refers to signs and symptoms secondary to compression of the left renal vein, most commonly between the superior mesenteric artery and the aorta, leading to impaired outflow to the vena cava. Diagnosis of this syndrome is often difficult and as result is late in most cases. We report on the case of a 51-year-old woman successfully treated with embolization of the ovarian vein and insertion of a self expandable stent in the left renal vein. Technical details and pitfalls are discussed.Keywords: Nutcracker Syndrome; Nutcracker phenomenon; renal vein entrapment; Pelvic Congestion Syndrome. ResumoA Síndrome do Quebra-nozes se refere a um conjunto de sinais secundários à compressão da veia renal esquerda, mais comumente entre a artéria mesentérica superior e a aorta, levando ao comprometimento do fluxo para a veia cava. O diagnóstico desta síndrome frequentemente é difícil e, por esta razão, o diagnóstico é demorado, em muitos casos. É relatado, nesta publicação, o caso de uma mulher de 51 anos, tratada com sucesso pela embolização da veia ovariana associada ao implante de stent autoexpansível na veia renal esquerda. São discutidos os aspectos técnicos e as dificuldades do procedimento. phlebography showed the superior mesenteric artery pressing down on the left renal vein and significant dilation of the ovarian vein (Figures 2 and 3). The short sheath was changed for an 8F long sheath and selective catheterization of ovarian vein was conducted preparatory to embolization with a Renegade® microcatheter and release four 12×30 mm Interlock® springs, followed by infusion of 5 ml of 3% polidocanol in a dense foam (Figure 4). A 16 mm×60 mm self-expanding Wallstent® was then implanted in the left renal vein and angioplasty conducted with a 12×40 mm XXL balloon, taking care to maintain an anchorage area both proximally and distally, to avoid migration to the cava ( Figure 5). Control phlebography showed that satisfactory correction of left renal vein compression and Palavras-chave:

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Section: Discussionmentioning

confidence: 99%

Tratamento endovascular da Sindrome de Quebra-nozes (Nutcracker)

Cunha

Souza

Feitosa³

et al. 2013

J. vasc. bras.

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“…2,5 The successful transposition of the left renal vein (renocaval reimplantation) has also been described. 1,6,7 Nephropexy was described in a situation in which true extrinsic compression by the SMA did not exist, but instead a stretch phenomenon with renal vein compression over the aorta due to posterior renal ptosis. 8 Renal autotransplantation has also been performed successfully.…”

Section: Discussionmentioning

confidence: 98%

Laparoscopic splenorenal venous bypass for nutcracker syndrome

Chung

Gill

2009

Journal of Vascular Surgery

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Nutcracker syndrome is a rare entity caused by extrinsic compression on the left renal vein as it crosses between the superior mesenteric artery and the aorta. It can clinically present with flank pain and hematuria. Accepted treatments include open vascular bypass procedures or endoluminal stenting. We present the first description, to our knowledge, of a laparoscopic splenic vein-left renal vein bypass to relieve the outflow obstruction. The patient, a 29-year-old woman with debilitating left flank pain, presented with nutcracker syndrome. Left renal vein outflow was obstructed at the level of the intersection between the aorta and the superior mesenteric artery. The option of laparoscopic splenic to left renal vein bypass was discussed and performed. A five-port transperitoneal approach was used. Meticulous vascular control was achieved with numerous laparoscopic vascular bulldog clamps. With completely intracorporeal suturing techniques, the splenic vein was anastomosed to the superior aspect of the anterior left renal vein. Total warm ischemia time was 37 minutes. The anastomosis was watertight immediately upon unclamping. Interestingly, upon unclamping, the luminal diameter of the splenic vein appeared to increase to twice its native diameter. The proximal left renal vein appeared less distended, indicating preferential venous outflow through the newly created venous bypass. Blood loss was minimal, no intraoperative or postoperative complications occurred, and the patient's symptoms improved. This report continues to augment the indications for laparoscopic surgery in even complex, urologic vascular situations.

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“…The available surgical procedures include intra- or extravascular stents[5] and open surgical procedures employed to rectify the problem include, the transposition of the left renal vein[6] transposition of the superior mesenteric artery[7] renal autotransplantation[8] and gonadocaval bypass[9] or nephrectomy, when there is severe organ damage. [10] The indications for laparoscopic surgery continue to expand for the treatment of the Nutcracker Syndrome: Retroperitoneal laparoscopic nephrectomy with ex-vitro autograft repair and autotransplantation[11] laparoscopic splenorenal venous bypass[12] laparoscopic extravascular renal vein stent placement[13] and laparoscopic inferior mesenteric-gonadal vein bypass.…”

Section: Discussionmentioning

confidence: 99%

Modified medial nephropexy for treatment of the anterior nutcracker syndrome

et al. 2014

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We report the case of a 15-year-old male, presenting with recurrent gross hematuria complicated by acute anemia. Cystoscopy showed little bleeding from the left ureteral orifice. Diagnosis of left renal vein compression at the aortomesenteric space was established through color Doppler ultrasonography and computed tomographic angiography. Therapeutic attitude was interventionist in our case, performing successful management with modified medial nephropexy, with a retroperitoneal approch. To the best of our knowledge, we report the second case of left medial nephropexy for treatment of the anterior nutcracker syndrome. The first case of modified medial nephropexy was done by lowering the left renal vein from its initial position in the aortomesenteric angle through a restrict retroperitoneal approach.

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Left renal venous hypertension “nutcracker” syndrome

Cited by 90 publications

References 15 publications

Tratamento endovascular da Sindrome de Quebra-nozes (Nutcracker)

Tratamento endovascular da Sindrome de Quebra-nozes (Nutcracker)

Laparoscopic splenorenal venous bypass for nutcracker syndrome

Modified medial nephropexy for treatment of the anterior nutcracker syndrome

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