Tratamiento endovascular exitoso del síndrome de cascanueces con stent autoexpandible

Abstract

Nutcracker's syndrome is caused by compression of the left renal vein between aorta and superior mesenteric artery, causing extrinsic compression generated functional stenosis. This causes congestion and hypertension of the left renal vein resulting in insufficiency and left gonadal vein varicose, unilateral hematuria and left flank pain, diagnosis is rarely identified by their low frequency and difficulty of suspecting, treatment of nutcracker's syndrome include renal autotransplantation, transposition of superior mesenteric artery revascularization and recently stenting in renal vein, we present the case of a patient, who showed this pathology by diagnostic support by image studies, was performed successfully implant a self-expanding stent with immediate success criteria by angiography, collateral reduction and by disappearance of cava/renal gradient.

Management of left renal vein compression in patients presenting left gonadal vein reflux

“…Stent migration is also mentioned as a complication in other previous works, 31,34–38 finding a 7.8% of stents migrated (10/127 cases). Of a total of 10 stent migrations checked, seven of them occur without clinical complications, two result in Nutcracker recurrence.…”

“…Some authors recommend medical treatment, but others suggest a surgical approach, including LRV transposition, LRV bypass, superior mesenteric artery transposition, kidney auto-transplantation, etc. 16,25–38 In one article, 127 of 139 patients were treated by stenting, all presenting satisfactory clinical outcomes with the exception of one case. 31…”

Diagnóstico e tratamento da síndrome de quebra-nozes (nutcracker ): revisão dos últimos 10 anos

“…27 However, information on long-term follow-up is still lacking, which justifies the reluctance to use it with young patients. 8,30,31 While it is a simple and attractive option, complications include stent migration, fractures, and venous occlusion. 28 The techniques used are embolization of the LGV and stent placement.…”