Renal nutcracker syndrome: Surgical options

Said, Sameh M.; Gloviczki, Péter; Kalra, Manju; Oderich, Gustavo S.; Duncan, Audra A.; Fleming, Mark D.; Bower, Thomas C.

doi:10.1053/j.semvascsurg.2013.04.006

Cited by 57 publications

(79 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Decrease of pelvic congestion and decompression of LRV can be obtained by left gonadal vein transposition. Saphenous vein also can be used for the bypass of the decompressed segment of the LRV [28] . Anterior transposition of LRV is used for posterior variant of NCS.…”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Nutcracker syndrome

Gulleroglu

Gülleroğlu

Baskın

2014

WJN

130

163

View full text Add to dashboard Cite

The nutcracker phenomenon [left renal vein (LRV) entrapment syndrome] refers to compression of the LRV most commonly between abdominal aorta and superior mesenteric artery. Term of nutcracker syndrome (NCS) is used for patients with clinical symptoms associated with nutcracker anatomy. LRV entrapment divided into 2 types: anterior and posterior. Posterior and right-sided NCSs are rare conditions. The symptoms vary from asymptomatic hematuria to severe pelvic congestion. Symptoms include hematuria, orthostatic proteinuria, flank pain, abdominal pain, varicocele, dyspareunia, dysmenorrhea, fatigue and orthostatic intolerance. Existence of the clinical features constitutes a basis for the diagnosis. Several imaging methods such as Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography and retrograde venography are used to diagnose NCS. The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension. The treatment options are ranged from surveillance to nephrectomy. Treatment decision should be based on the severity of symptoms and their expected reversibility with regard to patient's age and the stage of the syndrome.

show abstract

Section: Treatmentmentioning

confidence: 99%

“…Surgical procedures are used for treatment in patients with severe symptoms. Nephropexy, intravascular and [28] . LRV transposition is the most frequent and most effective technique in which LRV is transposed distally to the IVC.…”

Section: Treatmentmentioning

confidence: 99%

Nutcracker syndrome

Gulleroglu

Gülleroğlu

Baskın

2014

WJN

130

163

View full text Add to dashboard Cite

show abstract

“…Gross hematuria and severe symptoms including flank or pelvic pain and renal impairment are the best indicators for surgical intervention. 21,22 We did not observe microscopic or macroscopic hematuria or renal impairment in this case, and a vascular surgeon recommended medical therapy or close observation. Weight gain after laparoscopic duodenojejunostomy may increase retroperitoneal adipose tissue and re- …”

Section: 오명진 콩팥 호두까기 증후군이 동반된 위창자간막동맥 증후군 1예mentioning

confidence: 99%

Superior Mesenteric Artery Syndrome Combined with Renal Nutcracker Syndrome in a Young Male: A Case Report

2017

Korean J Gastroenterol

View full text Add to dashboard Cite

Superior mesenteric artery (SMA) syndrome is one of the rare causes of small bowel obstruction. It develops following a marked decrease in the angle between SMA and the abdominal aorta due to weight loss, anatomical anomalies, or following surgeries. Nutcracker syndrome in the left renal vein may also occur following a decrease in the aortomesenteric angle. Though SMA syndrome and renal nutcracker syndrome share the same pathogenesis, concurrent development has rarely been reported. Herein, we report a 23-year-old healthy male diagnosed with SMA syndrome and renal nutcracker syndrome due to severe weight reduction. The patient visited our outpatient clinic presenting bilious vomiting and indigested vomitus for 3 consecutive days. He had lost 20 kg during military service. We suspected SMA syndrome based on abnormal air-shadow in the stomach and small bowel on abdominal X-ray; we confirmed compression of the third portion of the duodenum with upper gastrointestinal series and abdominal computed tomography (CT). Concurrently, renal nutcracker syndrome was also detected via abdominal CT and Doppler ultrasound. Considering bilious vomiting and no urinary symptoms, SMA syndrome was corrected by laparoscopic duodenojejunostomy, and close observation for the renal nutcracker syndrome was recommended. (Korean J Gastroenterol 2017;70:253-260)

show abstract

“…In addition, there is a paucity of established treatment strategies, although current data suggest that treatment is warranted in patients with severe, recurrent, or disabling symptoms. 3 Lack of established NCS treatment guidelines may be related to both its rarity and some skepticism regarding its existence as a pathologic entity. The latter is largely because some degree of the LRV compression by the SMA and the aorta is considered to be physiologic, surgical ligation and division of the LRV during aortic aneurysm repair is well tolerated, and patients with LRV stretched taut over an aortic aneurysm are rarely symptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…Current treatment options include observation, surgical decompression, and endovascular stenting. 3,14 The most commonly used surgical and, more recently, endovascular treatment modalities are transposition of the LRV, great saphenous vein bypass, excision of fibrous compressive tissue, renal autotransplantation, external stenting of the LRV, and transluminal balloon angioplasty and stenting. [15][16][17] Reed et al 14 retrospectively evaluated their long-term results in 23 NCS patients treated with LRV transposition (n ¼ 11) for severe and classic NCS symptoms compared with observation alone (n ¼ 12) for mild or atypical symptoms.…”

Section: Discussionmentioning

confidence: 99%