What Each Clinical Anatomist Has to Know about Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome): A Review of the Most Important Findings

Abstract

Nutcracker syndrome (NCS) is the most common term for compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. The development of NCS is associated with the formation of the left renal vein (LRV) from the aortic collar during the sixth to eighth week of gestation and abnormal angulation of the superior mesenteric artery from the aorta. Collateralization of venous circulation is the most significant effect of NCS. It includes mainly the left gonadal vein and the communicating lumbar vein. Undiagnosed NCS may affect retroperitoneal surgery and other radiological and vascular procedures. The clinical symptoms of NCS may generally be described as renal presentation when symptoms like haematuria, left flank pain, and proteinuria occur, but urologic presentation is also possible. Radiological methods of confirming NCS include Doppler ultrasonography as a primary test, retrograde venography, which can measure the renocaval pressure gradient, computed tomography angiography, which is faster and less traumatic, intravascular ultrasound, and magnetic resonance angiography. Treatment can be conservative or surgical, depending on the severity of symptoms and degree of LRV occlusion. Nutcracker syndrome is worth considering especially in differential diagnosis of haematuria of unknown origin.

Unusual coexistence of double inferior vena cava with nutcracker syndrome–a case report and review of the literature

“…Unrecognised anomalies prior to medical procedures may lead to interruption of veins and severe haemorrhage. 3,4,6,8,9 To the best of the authors' knowledge, the present case is a unique description of duplicated IVC coexisting with nutcracker syndrome, presented using two complementary radiological techniques.…”

Circumaortic left renal vein (circumaortic renal collar) associated with the presence of vascular anomalies: a case series and review of literature

“…The aLRV may also be absent. In such cases, the single retroaortic left renal vein replaces the typical left renal vein [19,29]. Anjamrooz et al [1] described another case of the left renal vein bifurcating into two branches passing behind the aorta.…”

“…In particular, it applies to the left renal vein which can present retroaortic [1,10,12,15] or even circumaortic placement [7,11,13,20,27]. Thus, the left renal vein may be a single vessel or double -with two limbs: one located anterior and the second posterior to the abdominal aorta [5,19,33].…”

Síndromes compresivos vasculares: un desafío diagnóstico

“…6). 12,13 Su epidemiología, al igual que los demás síndromes vasculares, es desconocida debido a que en la mayoría de los casos se presentan de forma asintomática. El diagnóstico se realiza mediante la evaluación clínica, los hallazgos de laboratorio y la confirmación mediante estudios de imágenes.…”

“…Sin embargo, pueden manifestarse ambas entidades al mismo tiempo. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Los síntomas neurológicos pueden ser sensitivos (parestesias o dolor) y/o motores. Cuando se presenta por compresión arterial los síntomas son dolor, parestesias, frialdad y alteración en la temperatura (poiquilotermia).…”