Current management approach for left renal vein entrapment syndrome: the so-called ‘Nutcracker’ syndrome

Surgical Treatment of a Patient With Nutcracker Syndrome via Transposition of the Left Renal Vein

Introduction

Nutcracker syndrome (NCS) is caused by compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery (SMA) where it passes in the fork formed at the bifurcation of these arteries. NCS leads to LRV hypertension, resulting in left flank and abdominal pain, with or without haematuria and pelvic ureteral varices.

Report

The patient was a young female with diagnostic criteria of NCS, with severe clinical manifestations. The patient underwent transposition of the LRV approximately 3.0 cm below the original anatomic site and was anastomosed to the inferior vena cava (IVC) outside the meso-aortic compression zone.

Conclusion

Although NCS is not as common as other clinical scenarios, it may be encountered by physicians in a variety of disciplines, and can cause substantial morbidity and mortality rates. This report addresses the surgical approach used in a particular case, as well as the possible complications and outcomes if not treated in due time.

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A young female patient with diagnostic criteria of NCS, with severe clinical manifestations.

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The patient underwent transposition of the LRV approximately 3.5 cm below the original anatomic site.

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She was then anastomosed to the inferior vena cava (IVC) outside the meso-aortic compression zone.

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The symptoms were masked for an extended period of time, while the patient deteriorated at a rapid pace.

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At 36 months of follow-up the patient remained symptom free.