Aleksandra Policha1, Patrick Lamparello1, Mikel Sadek1, Todd Berland1, Thomas Maldonado2. 1. Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY. 2. Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY. Electronic address: thomas.maldonado@nyumc.org.
Abstract
BACKGROUND: Nutcracker syndrome, or mesoaortic compression of the left renal vein (LRV), with associated symptoms related to venous hypertension in the left kidney, is a rare entity that may result in severe symptoms requiring operative intervention. We report on 3 patients who presented with nutcracker syndrome, including one patient with a circumaortic LRV resulting in posterior nutcracker syndrome, who underwent successful endovascular treatment with renal vein stenting. A review of existing literature on endovascular management of nutcracker syndrome follows. METHODS: Three women (age range 28-43 years) presented with symptoms and imaging studies consistent with nutcracker syndrome. Symptoms included pelvic and flank pain in all 3 patients, and episodes of hematuria in 2 patients. Imaging studies demonstrated compression of the LRV between the superior mesenteric artery and aorta in 2 of the patients. The third patient was noted to have a circumaortic LRV. RESULTS: All 3 patients underwent venography and LRV stenting. Stents included a 12 × 40 mm self-expanding nitinol stent, 14 × 60 mm WALLSTENT, and 16 × 40 mm WALLSTENT. All patients were placed on clopidogrel postoperatively. The duration of follow-up ranged from 6 to 27 months. At follow-up, all 3 patients reported significant symptomatic improvement, and duplex ultrasonography demonstrated stent patency in all. CONCLUSIONS: Nutcracker syndrome is a rare condition that can be successfully treated with renal vein stenting via an endovascular approach. Results are encouraging at follow-up periods beyond 2 years.
BACKGROUND:Nutcracker syndrome, or mesoaortic compression of the left renal vein (LRV), with associated symptoms related to venous hypertension in the left kidney, is a rare entity that may result in severe symptoms requiring operative intervention. We report on 3 patients who presented with nutcracker syndrome, including one patient with a circumaortic LRV resulting in posterior nutcracker syndrome, who underwent successful endovascular treatment with renal vein stenting. A review of existing literature on endovascular management of nutcracker syndrome follows. METHODS: Three women (age range 28-43 years) presented with symptoms and imaging studies consistent with nutcracker syndrome. Symptoms included pelvic and flank pain in all 3 patients, and episodes of hematuria in 2 patients. Imaging studies demonstrated compression of the LRV between the superior mesenteric artery and aorta in 2 of the patients. The third patient was noted to have a circumaortic LRV. RESULTS: All 3 patients underwent venography and LRV stenting. Stents included a 12 × 40 mm self-expanding nitinol stent, 14 × 60 mm WALLSTENT, and 16 × 40 mm WALLSTENT. All patients were placed on clopidogrel postoperatively. The duration of follow-up ranged from 6 to 27 months. At follow-up, all 3 patients reported significant symptomatic improvement, and duplex ultrasonography demonstrated stent patency in all. CONCLUSIONS:Nutcracker syndrome is a rare condition that can be successfully treated with renal vein stenting via an endovascular approach. Results are encouraging at follow-up periods beyond 2 years.
Authors: Alex T Cubberley; Mohanad Hamandi; Courtney Rawitscher; Karim Al-Azizi; Sameh Sayfo; Srinivasa Potluri; Phillip A Morales; Javier Vasquez; Chadi Dib Journal: Proc (Bayl Univ Med Cent) Date: 2021-01-26