Interventional Management of a Rare Combination of Nutcracker and Wilkie Syndromes

Abstract

Nutcracker and Wilkie syndromes are rare mesoaortic compression entities, and their association is even less common. Data on interventional treatment of these pathologies are still scarce, but results from limited case series are encouraging. We report the case of a previously healthy 45-year-old woman diagnosed with nutcracker and Wilkie syndromes who presented with macroscopic hematuria, intermittent pain in the left flank and hypogastric region, postprandial nausea, and unexplained significant weight loss. A successful endovascular approach with stent implantation in the left renal vein was performed, but the stent migrated toward the left kidney, and this acute complication was managed through an interventional strategy as well. At the three-month follow-up, the patient described a marked improvement in all symptoms, except for the macroscopic hematuria. As it was our strong belief that the approach was efficient, we further investigated the “hematuria”, which eventually led to the diagnosis of endometrial carcinoma. A hysterectomy and bilateral adnexectomy were planned, and chemoradiotherapy was initiated with the goal of preoperative tumor reduction. To our knowledge, this is the first reported case in which both Wilkie and nutcracker syndromes were effectively treated by stent implantation in the left renal vein, complicated with very early stent migration due to inadequate apposition to the less compliant venous lumen. The treatment of the duodenal compression was indirectly included in the stenting of the left renal vein, as reclaiming the venous lumen widened the aortomesenteric angle. The aim of this review is to discuss our center’s transcatheter experience with these rare disorders and explore the literature in order to establish the benefits and limitations of such an approach.

A unique posterior nutcracker syndrome combined with Wilkie syndrome: A singular case

“…This combination is rarely described in the literature, and it is usually the anterior nutcracker syndrome that occurs in association with SMA syndrome, as they share the same aetiopathogenetic basis (i.e. compression of the left renal vein and duodenum, respectively, within the aortomesenteric angle) [ 9 , 10 ]. For these reasons, the co-occurrence of SMA and posterior nutcracker syndrome is even more unusual [ 11 ].…”

Correlation between Ultrasound Peak Systolic Velocity and Angiography for Grading Internal Carotid Artery Stenosis

“…However, it is an invasive procedure that could cause peri-operative complications. Moreover, it yields high X-ray exposure for both patients and personnel [17].…”

Síndrome de Wilkie como reto diagnóstico en obstrucción intestinal: reporte de caso

“…Otras causas que predisponen a esta enfermedad son lordosis grave, embarazo, mal rotación intestinal, neoplasias y quimioterapias (7,8) . Pruebas de imágenes son necesarias para realizar el diagnóstico, entre ellos destacan: el tránsito baritado esófago-gastro-duodenal, la ecografía abdominal, la angiografía mesentérica, endoscopia digestiva alta o preferentemente la tomografía por la función de poder realizar reconstrucciones multiplano, por su alto contraste, resolución espacial y temporal (9) . En la mayoría de los casos, el tratamiento conservador es posible; pero si eso falla, se requiere cirugía, que se puede realizar mediante cirugía abierta o cirugía laparoscópica (10) .…”