Nutcracker syndrome – treated by surgery

Dzsinich, Csaba; Tóth, Gyula Lukács; Nyiri, Gabriella; Vallus, Gábor; Berek, Peter; Barta, L

doi:10.1556/maseb.68.2015.1.2

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…At present, the treatment guidelines for NCS are unclear, and different therapeutic principles need to be applied in specific individuals depending on the severity of symptoms. Regardless of the use of a traditional open or minimally invasive approach, the relevant surgical procedures are all designed to relieve LRV hypertension (Dzsinich et al, 2015;Ananthan et al, 2017;Velasquez et al, 2018). Surgical treatment includes laparoscopic surgery, interventional therapy and open surgery.…”

Section: Introductionmentioning

confidence: 99%

3D-Printed PEEK Extravascular Stent in the Treatment of Nutcracker Syndrome: Imaging Evaluation and Short-Term Clinical Outcome

Da-li

Liang

Wang

et al. 2020

Front. Bioeng. Biotechnol.

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Minimally invasive options are safe and reliable alternatives for the treatment of nutcracker syndrome (NCS). After continued efforts, our team successfully devised a new and effective therapeutic method: 3D-printed extravascular stenting of the left renal vein. From December 2017 to May 2019, 28 patients (25 men and 3 women) from different parts of China between 18 and 37 years old (mean, 23.6 years) diagnosed with NCS were admitted for laparoscopic 3D-printed extravascular stenting treatment. The post-operative follow-up duration was 6-24 months (median, 16.3 months). Technical success of the operation was achieved in all patients. After treatment, the NCS symptoms all patients resolved or improved during the follow-up period, without relapse. Most symptoms, including macro-/microhematuria, proteinuria, and flank/abdominal pain, tended to resolve within 3-6 months after the surgery; other symptoms, such as left-sided varicocele, also showed varying degrees of improvement at different times post-operatively. Perioperative complications were noted in two patients, including transient and mild lymphatic leakage, without any adverse effects. All extravascular stents were visualized on computed tomography and Doppler ultrasound scans, and no migration or any side effects occurred during the entire follow-up period. Compared to endovascular stenting or polytetrafluoroethylene artificial vessel procedures, 3Dprinted polyetheretherketone extravascular stenting has more advantages in terms of stent design and rigidity and approach rationality while successfully preventing stent migration and thrombosis. Therefore, this method may serve as an accurate and effective treatment for NCS patients.

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Section: Introductionmentioning

confidence: 99%

3D-Printed PEEK Extravascular Stent in the Treatment of Nutcracker Syndrome: Imaging Evaluation and Short-Term Clinical Outcome

Da-li

Liang

Wang

et al. 2020

Front. Bioeng. Biotechnol.

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“…One should consider invasive treatment for patients diagnosed with NCS in whom conservative therapy has remained ineffective for more than 24 months and in those patients in whom severe symptoms or worsening of laboratory/imaging results persist ( 4 , 17 ). Surgical interventions, whether traditional open or minimally invasive surgery, mainly include transposition of the LRV or SMA, gonado-caval bypass, nephropexy, reno-caval reimplantation or kidney auto-transplantation, all of which are designed to relieve LRV hypertension ( 18 , 19 ). Some surgical procedures have an increased risk of complications, such as venous thrombosis, cardiovascular incidents, anastomotic bleeding, and restenosis ( 4 , 20 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

Successful Resolution of Nutcracker Syndrome with 3D Printed PEEK Extravascular Stent in an Adolescent Boy

Da-li¹

2022

acc

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Three-dimensional printed polyetheretherketone (PEEK) extravascular stent was applied to treat a 14-year-old boy with nutcracker syndrome. Digital subtraction angiography revealed a segment of the left renal vein (LRV) with reduced contrast filling immediately before its inflow into the inferior vena cava, and high-pressure gradient. The three-dimensional reconstruction model demonstrated that the LRV and the duodenum were contracted at the aortomesenteric angle, resulting in LRV compression from the abnormal high-level duodenal compartment. When duodenum courses between the abdominal aorta and superior mesenteric artery (duodenal interposition), the LRV entrapment occurs even at <90 aortomesenteric degrees. Three-dimensional printed PEEK extravascular stent was chosen to elevate the superior mesenteric artery and lower the duodenum position, thus relieving LRV compression. This extravascular application has significant advantages over open surgery, endovascular stenting and artificial vessel procedures with expanded polytetrafluoroethylene. It provides better cellular vitality by ensuring soft tissue proliferation. By reducing external acceleration and centrifugal force, a three-dimensional printed PEEK extravascular stent reduces adverse side effects. Such a stent has a distinctive personalized design, good stiffness, and durability that allows blood vessel growth, preventing stent migration and thrombosis. Therefore, it is suitable for both adult and pediatric patients. According to the abdominal ultrasound and multi-slice computed tomography scan, the postoperative follow-up results were satisfactory one year after surgery. The patient felt well, the blood flow in the LRV was not obstructed, and the blood flow velocity was average. The external stent was in place.

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“…Several surgical procedures have been tried in patients with a confirmed diagnosis of NCS and whose symptoms are severe enough to warrant a surgical solution. LRV transposition, involving transection of the LRV and moving it distally on the IVC where it is re-anastomosed, is the most frequently performed surgery to treat the condition [ 85 , 87 , 97 – 100 ]. Although decrease of pelvic congestion and/or gonadal vein engorgement can be obtained by left gonadal vein transposition or ligation, this procedure is not recommended without the appropriate resolution of LRV compression because of the possible increase in the renocaval pressure gradient [ 96 , 101 , 102 ].…”

Section: Introductionmentioning

confidence: 99%

Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature

Heidbreder

2018

J Med Case Reports

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BackgroundThe duodenum and the left renal vein occupy the vascular angle made by the superior mesenteric artery and the aorta. When the angle becomes too acute, compression of either structure can occur. Each type of compression is associated with specific clinical symptoms that constitute a rare disorder. If clinical symptoms are mild, conservative treatment is implemented. However, surgery is often the only solution that can improve quality of life and/or avoid life-threatening complications. This report describes a case of a patient with both types of aortomesenteric compression that required two separate surgeries to alleviate all symptoms.Case presentationA 20-year-old white woman presented to the Emergency Room complaining of sudden onset severe left flank and lower left quadrant abdominal pain, nausea, and vomiting. A clinical work-up revealed elevated white blood cells and hematuria. She was discharged with a diagnosis of urinary tract infection. Symptoms continued to worsen over the subsequent 2 months. Repeated and extensive clinical work-ups failed to suggest evidence of serious pathology. Ultimately, an endoscopy revealed obstruction of her duodenum, and barium swallow identified compression by the superior mesenteric artery, leading to the diagnosis of superior mesenteric artery syndrome. She underwent a Roux-en-Y duodenojejunostomy. Six weeks later she continued to have severe left-sided pain and intermittent hematuria. Venography revealed compression of the left renal vein, extensive pelvic varices, and significant engorgement of her left ovarian vein. A diagnosis of nutcracker syndrome was made and a left renal vein transposition was performed. Significant improvement was seen after 8 weeks.ConclusionsThe disorders associated with aortomesenteric compression can lead to serious symptoms and sometimes death. Diagnosis is challenging not only because of the lack of awareness of these rare disorders, but also because they are associated with symptoms that are similar to those seen in less serious diseases. Guidance for health care professionals with respect to relevant radiological and clinical markers needs to be reconsidered in order to clarify the etiology of the diseases and create better diagnostic protocols.

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Nutcracker syndrome – treated by surgery

Cited by 5 publications

References 23 publications

3D-Printed PEEK Extravascular Stent in the Treatment of Nutcracker Syndrome: Imaging Evaluation and Short-Term Clinical Outcome

3D-Printed PEEK Extravascular Stent in the Treatment of Nutcracker Syndrome: Imaging Evaluation and Short-Term Clinical Outcome

Successful Resolution of Nutcracker Syndrome with 3D Printed PEEK Extravascular Stent in an Adolescent Boy

Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature

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