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

Abstract

Resumo A síndrome de quebra-nozes é caracterizada por um grupo de manifestações clínicas que ocorrem por conta da compressão da veia renal esquerda. Seus principais sintomas são macro e micro-hematúria, proteinúria e dor no flanco. O diagnóstico é geralmente realizado após a exclusão de outras causas mais comuns, por conta da ausência de critérios clínicos para diagnóstico. Sua confirmação é feita por exames de imagem, com uso da ultrassonografia Doppler e tomografia computadorizada. O tratamento pode variar com as características do paciente e com a gravidade dos sintomas, e inclui o tratamento conservador, a cirurgia aberta e a cirurgia endovascular. Atualmente, a cirurgia aberta continua sendo a linha de frente, mas abordagens menos invasivas vêm ganhando cada vez mais espaço.

Tratamento endovascular da síndrome de quebra-nozes: relato de caso

“…Treatment for NCS varies depending on the patient's clinical severity and is reserved for symptomatic patients only. According to Macedo et al, 10 treatment for the syndrome remains a controversial subject, both the choice of the best modality to be used for each patient and the indications for treatment. Options include conservative treatment, open surgery with section of the fibrous ligament between the superior mesenteric artery and the aorta, transposition of the left renal vein, kidney autotransplantation, and even nephrectomy.…”

“…Options include conservative treatment, open surgery with section of the fibrous ligament between the superior mesenteric artery and the aorta, transposition of the left renal vein, kidney autotransplantation, and even nephrectomy. 6,10,11 These techniques can also be performed via laparoscopic access, but experience is limited. 12 Transposition of the renal vein has been the gold standard for treatment and proven effective.…”

“…13 Endovascular stent placement is usually preferable to open surgery, because of the long duration of renal congestion, the greater possibility of complications in these cases, and the need for extensive dissection in this type of operation. 10 Additionally, there is the possibility of simultaneous embolization of the gonadal vein and/or sclerosis with polidocanol directly into the pelvic varicose veins during the procedure. One study comparing 15 patients treated with endovascular methods against five patients treated using open surgery showed that, in the years following the procedure, all of the patients treated with stenting were asymptomatic.…”

Revascularização venosa via transposição de veia gonadal esquerda em síndrome de nutcracker posterior: relato de caso

“…8 For patients under the age of 18, or those with mild hematuria, the best option is conservative treatment with at least 2 years' follow-up. 4 A number of different open surgery techniques have been used, of which transposition of the LRV is the most common procedure. 9 Endovascular stenting can also be used, but it can be associated with adverse events such as stent migration, thrombosis, restenosis, deformities, and erosions.…”

“…3 Diagnosis is difficult, made on the basis of exclusion of other more prevalent causes, using imaging methods. 4 Treatment varies, ranging from conservative management, through open surgery, to modern endovascular methods with stenting. The objective of the present study is to discuss the case of a young patient, with posterior NCS, who was treated with open venous revascularization surgery with transposition of the left gonadal vein (LGV).…”