Endovascular treatment of anterior nutcracker syndrome and pelvic varices in a patient with an anterior and a posterior renal vein

Abstract

There are few data on endovascular treatment of anterior nutcracker syndrome and pelvic varices in patients with anterior and posterior renal veins. Our objective is to report a case, identify occurrences and compare diagnosis and treatments. A 42-year-old woman presented with flank and pelvic pain and hematuria. She had anterior nutcracker syndrome and pelvic varices with an anterior and a posterior renal vein. A successful complete endovascular approach was done with stent implantation in the anterior renal vein and left gonadal vein embolisation. After 12-month follow-up, the patient remained asymptomatic with good results on CT. Only two case reports of patients with nutcracker syndrome with anterior and posterior renal veins were identified. In both, a self-expanding stent was implanted in the anterior renal vein. In conclusion, endovascular treatment represents a safe and successful option in patients with nutcracker syndrome and pelvic varices with an anterior and a posterior renal vein.

Posterior nutcracker syndrome: a case report

“…An FR > 2.5 cm/s corresponds to a > 50% stenosis [ 17 ]; this latter is considered hemodynamically significant if >70%. The narrowed aorto-vertebral space (5.6 mm) did not provide, in our case, sufficient guarantees of the procedure's success and long-term endovascular stenting [ 18 ], while surgery, which is much more invasive than the interventional technique, was rejected by the patient. Considering FR and RI values (respectively just over 2.5 and 0.76), we decided to maintain a conservative therapeutic approach by monitoring renal functional parameters (creatininemia, glomerular filtrate) and the flow of the LRV with color and duplex Doppler US with a 6-month interval.…”

Endovascular treatment of a patient with nutcracker syndrome and pelvic varices involving anterior and posterior renal veins

“…In a previous study reported in 2020, we reported a case of anterior NS in a 42-year-old woman with an anterior and a posterior NS successfully treated with endovascular stent implantation in the renal vein anterior to the aorta and left gonadal vein embolization. 14 She showed complete clinical improvement and remained asymptomatic at 12 months postoperatively. In the same report, we identified previous occurrences and discussed the diagnosis and treatment based on a careful literature search of the main databases regarding NS.…”

“…In a previous paper published in 2020 14 , we reported a case of anterior NS in a 42-year-old woman with an anterior and a posterior NS successfully treated with endovascular stent implantation in the renal vein anterior to the aorta and left gonadal vein embolization. She showed complete clinical improvement, and remained asymptomatic 12 months after the procedure.…”

Wilkie Syndrome and Pseudo-Nutcracker Syndrome a Rare Combination: Description of a Case

“…WS treatment must also be decided on the basis of duodenal compression degree and should, in our opinion, rely on a high-calorie diet to restore normal perivascular adipose tissue. In case of diet failure we prefer endovascular stenting, because it is less invasive than surgical treatment; endovascular stent allows to restore regular flow in LRV and, at the same time, to widen AMA and AVS [ 10 ]. In our case, the excessive narrowness of AVS did not guarantee, in our opinion, a good long-term stent seal, and as there are still few cases reported in the literature [ 11 ], we chose a prophylactic treatment with anticoagulant drugs to prevent LRV thrombosis.…”