Renal nutcracker syndrome ncs is a condition that occurs when the left renal vein the vein that carries blood purified by the left kidney becomes compressed. Open surgical options include lvr or left gonadal vein transposition. The underlying anatomic anomaly, first described by gant in 1937, can lead to left renal venous. Renal vein entrapment the nutcracker syndrome brandon t. Surgical and endovascular interventions for nutcracker. Our vascular surgeon thinks that it is intimal hyperplasia. To evaluate outcomes of open surgery and endovascular interventions.
Left renal vein transposition for nutcracker syndrome. 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. I just recently had a major surgery for something called nutcracker syndrome. Nutcracker syndrome, or mesoaortic compression of the left renal vein. Long term complications in two patients after aortoaortic bypass for midaortic syndrome. Biotechnology industry high technology industry blood circulation disorders physiological aspects kidney kidneys vascular diseases veins.
Author links open overlay panel sridhar venkatachalam 1 kelly bumpus 2 samir r. Nutcracker syndrome wikimili, the free encyclopedia. He was the one who taught me about importance of the vascular system and. The patient demographics, surgical outcomes, and postoperative morbidities were.
Imaging findings and clinical features of abdominal. The posterior nutcracker syndrome is very rare and is considered when the left renal vein is compressed between the aorta and vertebral column. Nutcracker syndrome, caused by compression of the left renal vein lrv between the superior mesenteric artery and the aorta, results in left renal and gonadal venous hypertension. Nutcracker syndrome is caused by compression of the left renal vein between the superior mesenteric artery and the aorta. Diagnosis of pns is challenging, as symptoms are variable and not specific.
At the upmc heart and vascular institute, our surgeons in the division of vascular surgery are experts in treating nutcracker syndrome. Rudloff u1, holmes rj, prem jt, faust gr, moldwin r, siegel d. An unusual course of segmental renal artery displays a. Nutcracker phenomenon or renal vein entrapment is classically seen as a compression of renal vein in between abdominal aorta and superior mesenteric artery with patients being asymptomatic or clinically manifested in the form of nutcracker syndrome as proteinuria, hematuria, flank pain, pelvic congestion in women, and varicocele in men. Endovascular reconstruction of subclavian artery aneurysms in patients with arterial thoracic outlet syndrome.
Guide for authors annals of vascular surgery issn 0890. Nutcracker syndrome was first described by grant in 1937. Mesoaortic compression of the left renal vein nutcracker. Posterior nutcracker syndrome pns is a rare condition due to left renal vein lrv hypertension, caused by compression of the.
To assess diagnosis of the nutcracker renal vein entrapment syndrome with doppler ultrasonography us. Left renal vein lrv compression, commonly referred to as the nutcracker syndrome or renal vein entrapment syndrome, is a rare and often overlooked condition. Article in annals of vascular surgery 36 june 2016. Laparoscopic extravascular renal vein stent placement for. A new variant of the posterior nutcracker phenomenon. In collaboration with the dutch society of vascular surgery, the steering committee of the dutch surgical aneurysm audit and the dutch. Previous surgical corrections have focused on venous manipulation. Some people may not have symptoms, while others develop severe and. Nutcracker syndrome encompasses classical symptoms of hematuria and flank pain resulting from the compression of the left renal vein between the aorta and the superior mesenteric artery.
Doppler us findings in 16 patients with the nutcracker syndrome and in 18 healthy control subjects were compared. Treatment of nutcracker syndrome with open and endovascular. The nutcracker syndrome ncs results most commonly from the compression of the left renal vein lrv between the abdominal aorta aa and superior mesenteric artery sma, although other variants exist. Nutcracker syndrome is a very common condition that is present in almost 50% of women with other forms of pelvic vein disease, such as may thurner syndrome mts and pelvic congestion.
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. Laparoscopic left renal vein transposition for nutcracker. Meissner the nutcracker syndrome is characterized by entrapment and compression of the left renal vein between the abdominal aorta and the superior mesenteric artery sma figure 1. This is because both mts and pcs are anatomic variants in the structure of abdominal veins that predispose the patient to all three issues. This article describes the typical imaging findings and clinical features that are associated with four abdominal vascular compression syndromes. See more ideas about syndrome, nutcracker, superior mesenteric artery. Articles may be submitted for the following sections of the journal.
Annals of vascular surgery, volume 20, issue 1 springer. This syndrome results most commonly from the compression of the left renal vein between the abdominal aorta aa and superior mesenteric artery sma, although other variants exist. Symptoms of nutcracker syndromes may include intermittent left flank pain associated with hematuria, proteinuria, and sometimes with symptoms of pelvic congestion. Left renal vein transposition is an efficient surgical treatment for nutcracker syndrome. Surgery to treat the nutcracker syndrome in certain severe cases of the nutcracker syndrome, the doctor can suggest vascular surgery to help you get rid of the pressure on your left renal vein. The nutcracker syndrome is an unusual problem where the left renal vein is narrowed as it passes between an angle formed between the abdominal aorta and the superior mesenteric artery. Gonadal vein transposition for the treatment of nutcracker syndrome. Nutcracker syndrome ncs, which is caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery, leads to a series of clinical symptoms including. Nutcracker syndrome, also called renal nutcracker syndrome is a rare vascular condition. This entity is better known through its anterior variant, the anterior nutcracker phenomenon, where the anterior left renal vein is compressed between the aorta and the superior mesenteric artery. European journal of vascular and endovascular surgeryvol. Endovascular treatment of nutcracker syndrome request pdf.
Read surgical and endovascular interventions for nutcracker syndrome, seminars in vascular surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. To report our techniques and experience of laparoscopic extravascular stent placement for nutcracker syndrome. The name derives from the fact that, in the sagittal plane andor transverse plane, the sma and aa with some imagination appear to be a nutcracker crushing a nut the renal vein. To report our experience in the laparoscopic extravascular management of the nutcracker syndrome. Transposition of the left renal vein for the treatment of nutcracker syndrome in children.
Nutcracker syndrome ncs describes left renal vein compression. The surgical treatment suggested for the nutcracker syndrome includes moving the left renal vein to reattach it and a bypass surgery of the left renal vein. Endovascular treatment of nutcracker syndrome annals of. Posterior nutcracker syndrome pns is a rare condition due to left renal vein lrv hypertension, caused by compression of the lrv between the vertebral column and the abdominal aorta. Lyden and mehdi h shishehbor, journalannals of vascular surgery, year2011, volume25 8, pages 115464. What each clinical anatomist has to know about left renal. We explain the underlying pathophysiology that results in these clinical syndromes so that the patient subset who. The left renal vein lrv reimplantation into the distal inferior vena cava is considered to be the gold standard of care for symptomatic nutcracker syndrome ncs. Laparoscopic extravascular stent placement for nutcracker.
Annals of vascular surgery has a limited budget for publishing print color at no charge to the author. The vast majority of these surgical procedures are performed by open surgery. Anatomically, the lrv traverses the space between the superior mesenteric artery and the aorta in close proximity to the. Surgical treatment of posterior nutcracker syndrome sciencedirect. Three patients two men and one woman between the ages of 20 and 35 years mean 25. In patients with unexplained leftsided hematuria, flank pain or nonspecific abdominal pain, careful interrogation of diagnostic abdominal imaging should be performed to exclude the possibility of external. The anatomical configuration of these three structures was thought to resemble a nut in a nutcracker and hence the name.
Nutcracker syndrome or mesoaortic compression of the left renal vein lrv with associated symptoms related to venous. Robotic miniinvasive surgery of the nutcracker syndrome. Therapeutic options are debated, and either conservative, open, or endovascular approaches have been advocated as both safe and effective. Surgical treatment of a patient with nutcracker syndrome. Evolving trends in insurance coverage of vascular surgery patients. The term posterior nutcracker phenomenon refers to the compression of the retroaortic left renal vein between the aorta a and b, arrowhead and the vertebral column a and b, arrow. Clinical and surgical data and shortterm outcomes were analyzed retrospectively. Endovascular treatment of nutcracker syndrome journal of. Venkatachalam s1, bumpus k, kapadia sr, gray b, lyden s, shishehbor mh. It occurs when arteries compress the left renal kidney vein, often causing intermittent hematuria blood in the urine.
The nutcracker syndrome ncs occurs in the setting of compression of the lrv between the superior mesenteric artery sma, anteriorly, and the abdominal aorta, posteriorly. Diagnosis and surgical treatment of nutcracker syndrome. She had a ct last week that shows that the vein is narrowed again. Joye varghese s, naveen b et al, can pao2 levels predict hepatopulmonary syndrome. The classic symptoms of nutcracker syndrome include left flank pain with. Lyden and mehdi h shishehbor, journal annals of vascular surgery, year2011, volume25 8, pages 115464. Surgical treatment of posterior nutcracker syndrome.
In some cases however pelvic pain remains following left renal vein transposition. My daughter has nutcracker syndrome testicular disorders. Frank veith, one of the great vascular surgeons of my generation, and i knew i wanted to be like him. Renal nutcracker syndrome genetic and rare diseases. In this report, we are presenting a case of rare variant. Robotassisted laparoscopic left renal vein transposition for the treatment of nutcracker syndrome. Nutcracker syndrome ncs is the most common term for compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. Experiences with minimally invasive laparoscopic surgery in this field are very limited. Mesoaortic compression of the left renal vein nutcracker syndrome. What each clinical anatomist has to know about left renal vein entrapment syndrome nutcracker syndrome. I trained in general surgery and meant to become a heart surgeon. Robotassisted laparoscopic left renal vein transposition for the. This study included nutcracker syndrome patients who were treated by laparoscopic extravascular stent placement from june 2009 to august 20. Basic data underlying clinical decisionmaking in endovascular therapy.